Provider Demographics
NPI:1386744431
Name:CONSULTORIO CLINICO MEDICOS A SU ORDEN
Entity type:Organization
Organization Name:CONSULTORIO CLINICO MEDICOS A SU ORDEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICE
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIMILIEN
Authorized Official - Middle Name:RODOLFO
Authorized Official - Last Name:ESPINAL-U
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:787-242-0072
Mailing Address - Street 1:PO BOX 20000
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0042
Mailing Address - Country:US
Mailing Address - Phone:787-242-0072
Mailing Address - Fax:787-727-4794
Practice Address - Street 1:107 CALLE SANTA CECILIA
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00911-2202
Practice Address - Country:US
Practice Address - Phone:787-242-0072
Practice Address - Fax:787-727-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15414261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health