Provider Demographics
NPI:1659791606
Name:MDC INTERNAL MEDICINE PSC
Entity Type:Organization
Organization Name:MDC INTERNAL MEDICINE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-934-1393
Mailing Address - Street 1:AA18 CAMINO PANORAMICO
Mailing Address - Street 2:ALTAVILLA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:B-1 CALLE SANTA CRUZ
Practice Address - Street 2:CARIMED PLAZA SUITE 201
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6943
Practice Address - Country:US
Practice Address - Phone:787-294-9955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty