Provider Demographics
NPI:1073816575
Name:MEDICINA INTERNA LMG, CSP
Entity Type:Organization
Organization Name:MEDICINA INTERNA LMG, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-892-4357
Mailing Address - Street 1:PO BOX 1895
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1895
Mailing Address - Country:US
Mailing Address - Phone:787-892-4357
Mailing Address - Fax:787-659-7120
Practice Address - Street 1:AVE. INTERAMERICANA #153
Practice Address - Street 2:ESQ CHILIN QUINONES EDIF SAN JOSE #3
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-4357
Practice Address - Fax:787-659-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-06
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty