Provider Demographics
NPI:1275864605
Name:MEDICINA INTEGRAL 2010
Entity Type:Organization
Organization Name:MEDICINA INTEGRAL 2010
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ALCANTARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-817-3392
Mailing Address - Street 1:65 AVE BARBOSA
Mailing Address - Street 2:ARECIBO MEDICAL PLAZA 201
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-2799
Mailing Address - Country:US
Mailing Address - Phone:787-817-3392
Mailing Address - Fax:
Practice Address - Street 1:65 AVE BARBOSA
Practice Address - Street 2:ARECIBO MEDICAL PLAZA 201
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-2799
Practice Address - Country:US
Practice Address - Phone:787-817-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10873208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83690Medicare PIN