Provider Demographics
NPI:1154399673
Name:INSTITUTO DE MEDICINA AVANZADA SUNNY HILLS CSP
Entity type:Organization
Organization Name:INSTITUTO DE MEDICINA AVANZADA SUNNY HILLS CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-269-2641
Mailing Address - Street 1:88 CALLE ROBLE
Mailing Address - Street 2:CIUDAD JARDIN III
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4859
Mailing Address - Country:US
Mailing Address - Phone:787-269-2641
Mailing Address - Fax:
Practice Address - Street 1:B6 AVE SANTA JUANITA
Practice Address - Street 2:SUNNY HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-5026
Practice Address - Country:US
Practice Address - Phone:787-269-2641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty