Provider Demographics
NPI:1578574190
Name:CUMIC
Entity Type:Organization
Organization Name:CUMIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE UCC
Authorized Official - Prefix:DR
Authorized Official - First Name:NILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIO-FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-798-3001
Mailing Address - Street 1:PO BOX 1786
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-1786
Mailing Address - Country:US
Mailing Address - Phone:787-269-0988
Mailing Address - Fax:787-995-6925
Practice Address - Street 1:AVENIDA LAUREL
Practice Address - Street 2:ESQUINA SANTA JUANITA #100
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-269-0988
Practice Address - Fax:787-995-6925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
060890OtherCRUZ AZUL
=========61OtherINTERNATIONAL MEDICAL CAR
=========4OtherMCS ALIVIA
=========OtherCIGNA
=========OtherPREFERRED MEDICARE CHOICE
=========45OtherMEDICAL CARD SYSTEM
=========OtherCOSVI
=========OtherMAPFRE
=========OtherMMM
=========OtherMMM