Provider Demographics
NPI:1578370334
Name:CENTROCLINICODELSUR CORP
Entity type:Organization
Organization Name:CENTROCLINICODELSUR CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICO-
Authorized Official - Prefix:
Authorized Official - First Name:ELVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PACHECO BEGARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-0490
Mailing Address - Street 1:URBANIZACIN LOS CAOBOS CALLE CAOBAR 330
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2745
Mailing Address - Country:US
Mailing Address - Phone:787-840-0490
Mailing Address - Fax:787-651-6555
Practice Address - Street 1:URBANIZACIN LOS CAOBOS CALLE CAOBAR 330
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2745
Practice Address - Country:US
Practice Address - Phone:787-840-0490
Practice Address - Fax:707-651-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty