Provider Demographics
NPI:1285625483
Name:SYLCAB CSP
Entity type:Organization
Organization Name:SYLCAB CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBERA-OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MTMD MPH FAAFP
Authorized Official - Phone:787-798-5175
Mailing Address - Street 1:LOMAS VERDES Z-22 AVE LAUREL
Mailing Address - Street 2:
Mailing Address - City:BAYOMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-798-5175
Mailing Address - Fax:787-778-1505
Practice Address - Street 1:Z-22 AVE LAUREL
Practice Address - Street 2:LOMAS VERDES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-798-5175
Practice Address - Fax:787-778-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21456Medicare ID - Type Unspecified