Provider Demographics
NPI:1962514414
Name:CENTRO RENAL DE BAYAMON
Entity type:Organization
Organization Name:CENTRO RENAL DE BAYAMON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-288-5555
Mailing Address - Street 1:EL SENORIAL MAIL STATION MSC 536
Mailing Address - Street 2:WINSTON CHURCHILL 138
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-288-5555
Mailing Address - Fax:787-786-9824
Practice Address - Street 1:SANTA JUANITA SHOPPING COURT
Practice Address - Street 2:CALLE 30 ESQUINA 41
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-288-5555
Practice Address - Fax:787-786-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR95226261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17964OtherCOMMERCIAL PROVIDER NUMBE
PR=========OtherTAX ID NUMBER