Provider Demographics
NPI:1518338441
Name:CENTRO DE MEDICINA FAMILIAR Y CONTROL DE DOLOR
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA FAMILIAR Y CONTROL DE DOLOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-815-3239
Mailing Address - Street 1:HC 2 BOX 6870
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-9771
Mailing Address - Country:US
Mailing Address - Phone:787-815-3239
Mailing Address - Fax:787-650-9884
Practice Address - Street 1:CARR 638 KM 0.1
Practice Address - Street 2:DOMINGO RUIZ
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-815-3239
Practice Address - Fax:787-650-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020357Medicare UPIN