Provider Demographics
NPI:1285855411
Name:CANOVANAS MEDICAL GROUP
Entity Type:Organization
Organization Name:CANOVANAS MEDICAL GROUP
Other - Org Name:CANOVANAS MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:MS
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:MUJICA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-256-7642
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-0525
Mailing Address - Country:US
Mailing Address - Phone:787-256-7642
Mailing Address - Fax:787-876-5260
Practice Address - Street 1:61 CALLE PALMER
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3116
Practice Address - Country:US
Practice Address - Phone:787-256-7642
Practice Address - Fax:787-876-5260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA