Provider Demographics
NPI:1962541565
Name:CENTRO POLIMENONITA DE COAMO
Entity type:Organization
Organization Name:CENTRO POLIMENONITA DE COAMO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:CMA, MBA
Authorized Official - Phone:787-825-9237
Mailing Address - Street 1:CARR. 702 #5
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-825-9237
Mailing Address - Fax:787-825-7713
Practice Address - Street 1:CALLE MARIO BRASHI NO. 13
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-825-9237
Practice Address - Fax:787-825-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization