Basic Information
| Provider Information | |||||||||
| NPI: | 1952545279 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CIMA | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | CENTRO ISABELINO MEDICINA AVANZADA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 737 | ||||||||
| Address2: | |||||||||
| City: | ISABELA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006620737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878302725 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | AVE AGUSTIN RAMOS CALERO INTERIOR 111 | ||||||||
| Address2: | |||||||||
| City: | ISABELA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878302723 | ||||||||
| FaxNumber: | 7878300465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 04/30/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RIVERA | ||||||||
| AuthorizedOfficialFirstName: | FRANCISCO | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7878302725 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QV0200X | 07841 | PR | Y | Ambulatory Health Care Facilities | Clinic/Center | VA |
No ID Information.