Provider Demographics
NPI:1356764229
Name:CORP PARA EL DESARROLLO DE LA SALUD
Entity type:Organization
Organization Name:CORP PARA EL DESARROLLO DE LA SALUD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR EXECUTIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:BEHAR
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-995-1900
Mailing Address - Street 1:PO BOX 2759
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-2759
Mailing Address - Country:US
Mailing Address - Phone:787-995-1900
Mailing Address - Fax:787-269-7740
Practice Address - Street 1:CALLE MANUEL F. ROSSY, ESQ. ISABEL II
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-995-1900
Practice Address - Fax:787-269-7740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084412Medicare PIN