Provider Demographics
NPI:1518292986
Name:MEDICOS SELECTOS DE P.R. INC
Entity Type:Organization
Organization Name:MEDICOS SELECTOS DE P.R. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TESORERO
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUNDO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:787-717-5655
Mailing Address - Street 1:PO BOX 801293
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 CALLE LEPANTO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-1905
Practice Address - Country:US
Practice Address - Phone:787-717-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization