Provider Demographics
NPI:1629485073
Name:MEDICOS ALIADOS DEL NORESTE
Entity Type:Organization
Organization Name:MEDICOS ALIADOS DEL NORESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUB ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-887-0020
Mailing Address - Street 1:PO BOX 1515
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-1515
Mailing Address - Country:US
Mailing Address - Phone:787-887-0020
Mailing Address - Fax:787-887-0020
Practice Address - Street 1:CALLE 2 J2 VILLAS DE RIO GRANDE
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-0020
Practice Address - Fax:787-887-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10759305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service