Provider Demographics
NPI:1194172437
Name:CENTRO TERAS INC
Entity type:Organization
Organization Name:CENTRO TERAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ANEIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:URQUIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-462-5590
Mailing Address - Street 1:65 AVE DE INFANTERIA
Mailing Address - Street 2:PLAZA ITURREGUI SUITE 222
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-0000
Mailing Address - Country:US
Mailing Address - Phone:787-462-5590
Mailing Address - Fax:787-998-8811
Practice Address - Street 1:65 AVE DE INFANTERIA
Practice Address - Street 2:PLAZA ITURREGUI SUITE 222
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-0000
Practice Address - Country:US
Practice Address - Phone:787-462-5590
Practice Address - Fax:787-998-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000598261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR000598OtherLICENSE