Provider Demographics
NPI:1134374036
Name:CORPORACION DE SERVICIOS DE SALUD Y MEDICINA AVANZADA (COSSMA)
Entity type:Organization
Organization Name:CORPORACION DE SERVICIOS DE SALUD Y MEDICINA AVANZADA (COSSMA)
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTOVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ISOLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-739-8182
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:AVE. EL JIBARO CARR. 172 KM. 13.5
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1330
Mailing Address - Country:US
Mailing Address - Phone:787-739-8182
Mailing Address - Fax:787-739-8190
Practice Address - Street 1:AVE. EL JIBARO KM. 13.5
Practice Address - Street 2:CARR. 172
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-1330
Practice Address - Country:US
Practice Address - Phone:787-739-8182
Practice Address - Fax:787-739-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental