Provider Demographics
NPI:1609199306
Name:HEALTH MED CARE,CSP
Entity Type:Organization
Organization Name:HEALTH MED CARE,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIDALIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:CABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-458-2300
Mailing Address - Street 1:16 CALLE L
Mailing Address - Street 2:PARC. RODRIGUEZ OLMO
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4201
Mailing Address - Country:US
Mailing Address - Phone:787-458-2300
Mailing Address - Fax:
Practice Address - Street 1:CARR 668
Practice Address - Street 2:FELIX CORDOBA DAVILA 158
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-458-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14451261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBC8006149OtherFEDERAL
PRBC8006149OtherFEDERAL