# CENTRO DE MEDICINA PRIMARIA BAYAMON INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366630360
- **Authorized official:** DR. ROBERTO A RODRIGUEZ M.D. (PRESIDENTE)
- **Authorized official phone:** (787) 269-9944

## Contact information

- **Practice address:** D54 AVE LAUREL, URB. SANTA JUANITA, BAYAMON, PR 00956-4661
- **Practice address phone:** (787) 269-9944
- **Practice address fax:** (787) 269-9944
- **Mailing address:** 1168 CALLE FINLANDIA, URB. PLAZA DE LAS FUENTES, TOA ALTA, PR 00953-3809
- **Mailing address phone:** (787) 269-9944
- **Mailing address fax:** (787) 269-9944

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 173571 | PR | Yes |

## Other

- **Enumeration date:** 10/04/2007
- **Last updated:** 10/04/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0022373 | MEDICARE | PR |
| 01 | — | 22373 | SSS | PR |
| 01 | — | 3834 | PMC PREFERRED MEDICAL CHO | PR |
| 01 | — | 500437 E | MEDICARE Y MUCHO MAS | PR |
| 01 | — | 9090173 | HUMANA GOLD CHOICE | PR |