Provider Demographics
NPI:1629009527
Name:POLICLINICAS MEDICAS ASOCIADAS, INC.
Entity Type:Organization
Organization Name:POLICLINICAS MEDICAS ASOCIADAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:REYES
Authorized Official - Last Name:CABEZA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-856-8274
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:1575 AVE MUNOZ RIVERA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0211
Mailing Address - Country:US
Mailing Address - Phone:787-842-8945
Mailing Address - Fax:787-290-4472
Practice Address - Street 1:2015 AVE LAS AMERICAS SUITE 101
Practice Address - Street 2:PLAZOLETA LAS AMERICAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-842-8945
Practice Address - Fax:787-842-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherFEDERAL TAX ID