Provider Demographics
NPI:1396158242
Name:ACO SALUD CLINICA MULTIDISCIPLINARIA SURESTE INC
Entity type:Organization
Organization Name:ACO SALUD CLINICA MULTIDISCIPLINARIA SURESTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BENGOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-625-2500
Mailing Address - Street 1:URB. CARIBE
Mailing Address - Street 2:1551 ALDA STREET
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00926
Mailing Address - Country:UM
Mailing Address - Phone:787-625-2500
Mailing Address - Fax:787-679-3950
Practice Address - Street 1:CALLE PALMER
Practice Address - Street 2:ESQ VICENTE PALES
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-625-2500
Practice Address - Fax:787-679-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332068302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization