Provider Demographics
NPI:1275899817
Name:ADRIALEX,INC.
Entity Type:Organization
Organization Name:ADRIALEX,INC.
Other - Org Name:CENTRO VISUAL MIRADA DEL ESTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-206-2410
Mailing Address - Street 1:BZ. 738 BO.DAGUAO
Mailing Address - Street 2:
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-2903
Mailing Address - Country:US
Mailing Address - Phone:787-206-2410
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION JUAN MENDOZA
Practice Address - Street 2:CALLE 3 # 1
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-206-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR487/281261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care