Provider Demographics
NPI:1689969123
Name:MONA MED GROUP INC.
Entity Type:Organization
Organization Name:MONA MED GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-662-7887
Mailing Address - Street 1:430 CALLE ISMAEL RIVERA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-3312
Mailing Address - Country:US
Mailing Address - Phone:787-662-7887
Mailing Address - Fax:
Practice Address - Street 1:430 CALLE ISMAEL RIVERA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3312
Practice Address - Country:US
Practice Address - Phone:787-662-7887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR40D2021126291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory