Provider Demographics
NPI:1700220480
Name:OCEANIA MEDICAL CENTER PSC
Entity Type:Organization
Organization Name:OCEANIA MEDICAL CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-638-0064
Mailing Address - Street 1:76 TWILIGHT ST
Mailing Address - Street 2:SUNRISE AT PALMAS
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-638-0064
Mailing Address - Fax:787-734-2737
Practice Address - Street 1:76 TWILIGHT ST
Practice Address - Street 2:SUNRISE AT PALMAS
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-638-0064
Practice Address - Fax:787-734-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15122261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty