Provider Demographics
NPI:1700045697
Name:MEDICOS ASOCIADOS DE SANTA ISABEL, C.S.P.
Entity Type:Organization
Organization Name:MEDICOS ASOCIADOS DE SANTA ISABEL, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MALDONADO TORRES
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-637-4616
Mailing Address - Street 1:PO BOX 801425
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1425
Mailing Address - Country:US
Mailing Address - Phone:787-845-4933
Mailing Address - Fax:787-843-8173
Practice Address - Street 1:18 CALLE HOSTOS
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2646
Practice Address - Country:US
Practice Address - Phone:787-845-7492
Practice Address - Fax:787-843-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8032302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization