Provider Demographics
NPI:1194936203
Name:CENTRO INTEGRAL DE MEDICINA
Entity type:Organization
Organization Name:CENTRO INTEGRAL DE MEDICINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-860-1166
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:PUERTO REAL
Mailing Address - State:PR
Mailing Address - Zip Code:00740
Mailing Address - Country:US
Mailing Address - Phone:787-860-1166
Mailing Address - Fax:787-860-1166
Practice Address - Street 1:AVE. CONQUISTADOR A45, MONTE BRISAS
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-1166
Practice Address - Fax:787-860-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care