Provider Demographics
NPI:1376878967
Name:BELLADONNA MEDICAL WELLNESS
Entity Type:Organization
Organization Name:BELLADONNA MEDICAL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CINTRON-PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-533-7520
Mailing Address - Street 1:4253 CARR 2
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-3619
Mailing Address - Country:US
Mailing Address - Phone:787-533-7520
Mailing Address - Fax:
Practice Address - Street 1:CARR #2 KM 42
Practice Address - Street 2:EXPRESO VEGA Y MOROVIS
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-533-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRUPO MEDICO FAMILIAR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty