Provider Demographics
NPI:1194959122
Name:CENTRO CESKI C S P
Entity type:Organization
Organization Name:CENTRO CESKI C S P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-836-3288
Mailing Address - Street 1:602 CALLE JOSE V RODRIGUEZ
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-1807
Mailing Address - Country:US
Mailing Address - Phone:787-836-3288
Mailing Address - Fax:787-836-3288
Practice Address - Street 1:602 CALLE JOSE V RODRIGUEZ
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624-1807
Practice Address - Country:US
Practice Address - Phone:787-836-3288
Practice Address - Fax:787-836-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8333261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty