| NPI | 1154864361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUIS RIVERA SANTIAGO Presidente 787-690-0598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: PR 9458) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2016-11-21 |