Provider Demographics
NPI:1902859564
Name:CENTRO DE ENFERMEDADES ALERGICAS Y AMBIENTALES, C.S.P.
Entity Type:Organization
Organization Name:CENTRO DE ENFERMEDADES ALERGICAS Y AMBIENTALES, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:ZARAGOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-764-0078
Mailing Address - Street 1:PO BOX 140100
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0100
Mailing Address - Country:US
Mailing Address - Phone:787-764-0078
Mailing Address - Fax:787-753-3702
Practice Address - Street 1:525 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 808 TORRE DE PLAZA LAS AMERICAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-8001
Practice Address - Country:US
Practice Address - Phone:787-764-0078
Practice Address - Fax:787-753-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2009-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3004207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085475Medicare PIN