# COSTA ESTE MEDICAL SERVICES CORP

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

## Provider details

- **NPI number:** 1548430689
- **Authorized official:** DR. ISMARY M. GONZALEZ M.D. (PRESIDENT)
- **Authorized official phone:** (787) 860-5002

## Contact information

- **Practice address:** F5 CALLE PRINCIPAL, URB. BARALT, FAJARDO, PR 00738-3798
- **Practice address phone:** (787) 860-5002
- **Practice address fax:** (787) 860-3800
- **Mailing address:** PO BOX 1001, LUQUILLO, PR 00773-1001
- **Mailing address phone:** (787) 860-5002
- **Mailing address fax:** (787) 860-3800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | PR | Yes |

## Other

- **Enumeration date:** 03/05/2008
- **Last updated:** 07/21/2022