| NPI | 1245653682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HIPOLITO BLADIMIR COSTA PEREZ President 787-467-1007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2014-01-21 |