Provider Demographics
NPI:1962949040
Name:CENTRO INTEGRAL MULTIDICIPLINARIO DE AIBONITO
Entity type:Organization
Organization Name:CENTRO INTEGRAL MULTIDICIPLINARIO DE AIBONITO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COORDINADOR FACTURACION Y COBRO CIM
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:RODRIGUEZ RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-434-1700
Mailing Address - Street 1:PO BOX 372800
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-2800
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1714
Practice Address - Street 1:CALLE SARGENTO GERARDO SANTIAGO
Practice Address - Street 2:CARRETERA 14 INTERIOR
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-1379
Practice Address - Country:US
Practice Address - Phone:787-434-1700
Practice Address - Fax:787-434-1714
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO INTEGRAL MULTIDICIPLINARIO DE AIBONITO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR404009Medicare UPIN