Provider Demographics
NPI:1043586506
Name:M & Y MEDICAL SERVICES, CSP
Entity Type:Organization
Organization Name:M & Y MEDICAL SERVICES, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEICY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS LLAVONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-882-0303
Mailing Address - Street 1:PO BOX 250479
Mailing Address - Street 2:BO VICTORIA
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0479
Mailing Address - Country:US
Mailing Address - Phone:787-882-0303
Mailing Address - Fax:787-882-2866
Practice Address - Street 1:ROAD 2
Practice Address - Street 2:BO VICTORIA
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00604-0479
Practice Address - Country:US
Practice Address - Phone:787-882-0303
Practice Address - Fax:787-882-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN