Provider Demographics
NPI:1467828236
Name:CENTRO ESPECIALIZADO DE CIRUGIA COLORECTAL DE PUERTO RICO
Entity type:Organization
Organization Name:CENTRO ESPECIALIZADO DE CIRUGIA COLORECTAL DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SECRETARY, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:AURA
Authorized Official - Middle Name:FERNANDA
Authorized Official - Last Name:DELGADO-CIFUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-220-3235
Mailing Address - Street 1:672 CALLE MERIDA
Mailing Address - Street 2:URB VENUS GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4613
Mailing Address - Country:US
Mailing Address - Phone:787-220-3235
Mailing Address - Fax:
Practice Address - Street 1:AVE LAS LOMAS SUITE 202
Practice Address - Street 2:TORRE MEDICAL HOSPITAL METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-220-3235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20739208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty