Provider Demographics
NPI:1043762727
Name:CORPORACION DE SALUD ASEGURADA POR NUESTRA ORGANIZACION SOLIDARIA, INC
Entity type:Organization
Organization Name:CORPORACION DE SALUD ASEGURADA POR NUESTRA ORGANIZACION SOLIDARIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTIJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-745-0340
Mailing Address - Street 1:PO BOX 1025
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1025
Mailing Address - Country:US
Mailing Address - Phone:787-745-0340
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA RAFAEL CORDERO ESQUINA TROCHE
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-0340
Practice Address - Fax:787-746-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-28
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRIR007AOtherMEDICARE PTAN