Provider Demographics
NPI:1679529648
Name:CENTRO MEDICO CENTRAL COTO LAUREL, INC
Entity type:Organization
Organization Name:CENTRO MEDICO CENTRAL COTO LAUREL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-842-7856
Mailing Address - Street 1:103 CALLE CENTRAL
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2103
Mailing Address - Country:US
Mailing Address - Phone:787-842-7856
Mailing Address - Fax:787-842-7836
Practice Address - Street 1:103 CALLE CENTRAL
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2145
Practice Address - Country:US
Practice Address - Phone:787-842-7856
Practice Address - Fax:787-842-7836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12464174400000X
PR2615174400000X
PR14978174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR85030Medicare ID - Type Unspecified