Provider Demographics
NPI:1306544028
Name:ATLANTIC WELLNESS MD
Entity type:Organization
Organization Name:ATLANTIC WELLNESS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MENDEZ-ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-544-3188
Mailing Address - Street 1:EDIF. MANUEL BUNDY JIMENEZ
Mailing Address - Street 2:AVE. VICTOR ROJAS SUITE #3
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612
Mailing Address - Country:US
Mailing Address - Phone:787-544-3188
Mailing Address - Fax:787-544-3188
Practice Address - Street 1:EDIF. MANUEL BUNDY JIMENEZ
Practice Address - Street 2:AVE. VICTOR ROJAS SUITE #3
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-544-3188
Practice Address - Fax:787-544-3188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty