Provider Demographics
NPI:1063184950
Name:CENTRO VISUAL RIO HONDO CSP
Entity type:Organization
Organization Name:CENTRO VISUAL RIO HONDO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIMER ARSUAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-798-9491
Mailing Address - Street 1:DD16 CALLE 25
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3804
Mailing Address - Country:US
Mailing Address - Phone:787-798-9491
Mailing Address - Fax:
Practice Address - Street 1:DD16 CALLE 25
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3804
Practice Address - Country:US
Practice Address - Phone:787-798-9491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038744900Medicaid