Provider Demographics
NPI:1154961613
Name:CENTRALIS MED LLC
Entity type:Organization
Organization Name:CENTRALIS MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-510-6187
Mailing Address - Street 1:5016 PASEO LA CONSTANCIA
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2311
Mailing Address - Country:US
Mailing Address - Phone:787-510-6187
Mailing Address - Fax:787-848-1588
Practice Address - Street 1:AVE. BAIROA, HOSPITAL PANAMERICANO
Practice Address - Street 2:BAIROA SHOPPING CENTER #126
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-510-6187
Practice Address - Fax:787-848-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty