Provider Demographics
NPI:1629755376
Name:MADERA MEDICAL LLC
Entity Type:Organization
Organization Name:MADERA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-814-8049
Mailing Address - Street 1:PO BOX 9548
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9548
Mailing Address - Country:US
Mailing Address - Phone:787-614-2511
Mailing Address - Fax:787-814-8048
Practice Address - Street 1:EDIF MENDEZ CARR 119 KM 6.1
Practice Address - Street 2:BO PUENTE
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-814-8049
Practice Address - Fax:787-814-8048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty