Provider Demographics
NPI:1679950059
Name:MEDICOS ASOCIADOS DE PONCE
Entity Type:Organization
Organization Name:MEDICOS ASOCIADOS DE PONCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATICELLI
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-840-2418
Mailing Address - Street 1:9140 MARINA STREET SUITE 507
Mailing Address - Street 2:PONCIANA BUILDING
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-840-2418
Mailing Address - Fax:787-840-2418
Practice Address - Street 1:MARINA STREET 9140 PONCIANA BUILDING
Practice Address - Street 2:SUITE 507
Practice Address - City:PONCE
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00717
Practice Address - Country:UM
Practice Address - Phone:787-840-2418
Practice Address - Fax:787-840-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization