Provider Demographics
NPI:1538458161
Name:CONSULTORIO MEDICO MLO INC
Entity Type:Organization
Organization Name:CONSULTORIO MEDICO MLO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:ORTIZ DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-650-1363
Mailing Address - Street 1:PO BOX 142784
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2784
Mailing Address - Country:US
Mailing Address - Phone:787-650-1363
Mailing Address - Fax:787-650-1363
Practice Address - Street 1:CALLE MARGINAL CARR 129
Practice Address - Street 2:SECTOR DENTON
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-650-1363
Practice Address - Fax:787-650-1363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty