Provider Demographics
NPI:1962905729
Name:E M A MED SERV CSP
Entity type:Organization
Organization Name:E M A MED SERV CSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELENDEZ GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-642-3989
Mailing Address - Street 1:PO BOX 3246
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-3246
Mailing Address - Country:US
Mailing Address - Phone:939-642-3989
Mailing Address - Fax:787-839-0379
Practice Address - Street 1:7 CALLE SOL
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2703
Practice Address - Country:US
Practice Address - Phone:787-839-0379
Practice Address - Fax:787-839-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care