Provider Demographics
NPI:1487865382
Name:MEDICINA INTEGRAL Y PREVENTIVA INC.
Entity Type:Organization
Organization Name:MEDICINA INTEGRAL Y PREVENTIVA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICINE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN CALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-849-3845
Mailing Address - Street 1:PMB 154 P.O.BOX 5103
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-849-3845
Mailing Address - Fax:787-849-3845
Practice Address - Street 1:PLAZA CONSTANCIA PISO 2 CARR. #2
Practice Address - Street 2:
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-849-3845
Practice Address - Fax:787-849-3845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14386208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22950Medicare ID - Type Unspecified