Provider Demographics
NPI:1053397943
Name:CENTRO ESPECIALIZADO EN SALUD SSVP, INC
Entity type:Organization
Organization Name:CENTRO ESPECIALIZADO EN SALUD SSVP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:DR
Authorized Official - First Name:CESAR IVAN
Authorized Official - Middle Name:VARGAS
Authorized Official - Last Name:QUINONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-896-3165
Mailing Address - Street 1:18 URB RAHOLISA GDNS
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2418
Mailing Address - Country:US
Mailing Address - Phone:787-896-3165
Mailing Address - Fax:787-280-0330
Practice Address - Street 1:4100 AVE ARCADIO ESTRADA
Practice Address - Street 2:STE 222
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-3216
Practice Address - Country:US
Practice Address - Phone:787-896-3280
Practice Address - Fax:787-280-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4847207RC0000X
PR16662085R0202X
PR12045208D00000X
PR16227208D00000X
PR15963208D00000X
PR16148208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6600570426OtherPMC MEDICARE CHOICE
PR6600570426OtherPMC MEDICARE CHOICE
PR6600570426OtherPMC MEDICARE CHOICE