Provider Demographics
NPI:1649480153
Name:DAJAOS MEDICAL CENTER CSP
Entity type:Organization
Organization Name:DAJAOS MEDICAL CENTER CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-730-3446
Mailing Address - Street 1:RR 5 BOX 5334
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9711
Mailing Address - Country:US
Mailing Address - Phone:787-730-3446
Mailing Address - Fax:
Practice Address - Street 1:167 ROAD KM 11
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9711
Practice Address - Country:US
Practice Address - Phone:787-730-3446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9999261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6320088OtherHUMANA
PR065480OtherCRUZ AZUL
PR2081OtherSMERICAN HEALTH
PR82253OtherSSS
PR201279OtherPREFERED
PR500140EOtherCRUZ AZUL
PRN198OtherFIRS T PLUS
PR82154Medicare ID - Type Unspecified
PR201279OtherPREFERED