Provider Demographics
NPI:1992725402
Name:SERVICIOS DE SALUD PRIMARIOS DE AGUAS BUENAS, CSP
Entity type:Organization
Organization Name:SERVICIOS DE SALUD PRIMARIOS DE AGUAS BUENAS, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIO ADMINISTRADOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-732-0755
Mailing Address - Street 1:PO BOX 1490
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-1490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LUIS M. RIVERA #105
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-1490
Practice Address - Country:US
Practice Address - Phone:787-732-0755
Practice Address - Fax:787-732-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization