Provider Demographics
NPI:1124617444
Name:CENTRO DE MEDICINA FAMILIAR LLC
Entity type:Organization
Organization Name:CENTRO DE MEDICINA FAMILIAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICINE DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAND ROLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-888-0576
Mailing Address - Street 1:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-2225
Mailing Address - Country:US
Mailing Address - Phone:787-888-0576
Mailing Address - Fax:939-221-2393
Practice Address - Street 1:A4 CALLE GARCIA DE LA NOC
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-2859
Practice Address - Country:US
Practice Address - Phone:787-888-0576
Practice Address - Fax:939-221-2393
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO DE MEDICINA FAMILIAR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-12
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty