Provider Demographics
NPI:1073706644
Name:CORPORACION MEDICA ORIENTAL
Entity Type:Organization
Organization Name:CORPORACION MEDICA ORIENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYLENE
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:PRATTS DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-285-5959
Mailing Address - Street 1:100 CALLE MUNOZ MARIN
Mailing Address - Street 2:INTERIOR
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3455
Mailing Address - Country:US
Mailing Address - Phone:787-285-5959
Mailing Address - Fax:
Practice Address - Street 1:100 CALLE MUNOZ MARIN
Practice Address - Street 2:INTERIOR
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3455
Practice Address - Country:US
Practice Address - Phone:787-285-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization