Provider Demographics
NPI:1043675622
Name:CENTRO DE MEDICINA INTEGRAL DE MANATI,INC
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA INTEGRAL DE MANATI,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILDALIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-884-4700
Mailing Address - Street 1:PO BOX 4317
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-4317
Mailing Address - Country:US
Mailing Address - Phone:787-884-4700
Mailing Address - Fax:787-884-9719
Practice Address - Street 1:77 BO COTTO
Practice Address - Street 2:URBANIZACION FELIX CORDOVA DAVILA
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-884-4700
Practice Address - Fax:787-884-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal