Provider Demographics
NPI:1104896190
Name:CENTRO DE SERVICIOS PRIMARIOS DE SALUD INC
Entity type:Organization
Organization Name:CENTRO DE SERVICIOS PRIMARIOS DE SALUD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOSTINI VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-822-2170
Mailing Address - Street 1:3 ANTONIO ALCAZAR ST
Mailing Address - Street 2:PO BOX 368
Mailing Address - City:FLORIDA
Mailing Address - State:PR
Mailing Address - Zip Code:00650-0368
Mailing Address - Country:US
Mailing Address - Phone:787-822-2170
Mailing Address - Fax:787-822-7026
Practice Address - Street 1:3 ANTONIO ALCAZAR ST
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-0368
Practice Address - Country:US
Practice Address - Phone:787-822-2170
Practice Address - Fax:787-822-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80090Medicare PIN
PR30752Medicare PIN
PR4020107Medicare PIN