Provider Demographics
NPI:1225454697
Name:MEDICAL CARE CLINIC INC.
Entity Type:Organization
Organization Name:MEDICAL CARE CLINIC INC.
Other - Org Name:MEDICC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-977-7575
Mailing Address - Street 1:602 AVE FERNANDEZ JUNCOS
Mailing Address - Street 2:BOX 2300
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3149
Mailing Address - Country:US
Mailing Address - Phone:787-636-2309
Mailing Address - Fax:787-977-7610
Practice Address - Street 1:150 AVE DE DIEGO
Practice Address - Street 2:OFIC. 101
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2300
Practice Address - Country:US
Practice Address - Phone:787-977-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I43968Medicare UPIN
PR23420Medicare PIN