Provider Demographics
NPI:1053569392
Name:ST. CROIX PLASTIC SURGERY INC.
Entity type:Organization
Organization Name:ST. CROIX PLASTIC SURGERY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:CENTENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:340-227-2777
Mailing Address - Street 1:PO BOX 24330
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00824-0330
Mailing Address - Country:US
Mailing Address - Phone:340-719-2777
Mailing Address - Fax:340-719-2772
Practice Address - Street 1:#12 BEESTON HILL
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-719-2777
Practice Address - Fax:340-719-2772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1428261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VI1053452821OtherTYPE I NPI