Provider Demographics
NPI:1023565801
Name:ALZHEIMER'S PREVENTION CLINIC & RESEARCH CENTER-PR
Entity Type:Organization
Organization Name:ALZHEIMER'S PREVENTION CLINIC & RESEARCH CENTER-PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELENDEZ-CABRERO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:787-457-7219
Mailing Address - Street 1:PO BOX 194589
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4589
Mailing Address - Country:US
Mailing Address - Phone:787-457-7219
Mailing Address - Fax:939-437-4397
Practice Address - Street 1:867 AVE MUNOZ RIVERA
Practice Address - Street 2:EDIF VICK CENTER SUITE B-101
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-2102
Practice Address - Country:US
Practice Address - Phone:939-645-8154
Practice Address - Fax:939-437-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2764302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization