# LUQUILLO- OPD

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PUERTO RICO PRIMARY CARE MSO, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043964141
- **Legal business name:** PUERTO RICO PRIMARY CARE MSO, INC.
- **Authorized official:** KEILA CENTENO (ADMINISTRATOR)
- **Authorized official phone:** (787) 534-3789

## Contact information

- **Practice address:** CALLE 14 DE JULIO NO 159, BO MATA DE PLATANO, LUQUILLO, PR 00773
- **Practice address phone:** (787) 885-4446
- **Practice address fax:** (787) 885-6129
- **Mailing address:** PO BOX 818, CEIBA, PR 00735-0818
- **Mailing address phone:** (787) 534-3789
- **Mailing address fax:** (787) 885-2525

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/08/2022
- **Last updated:** 02/08/2022