Provider Demographics
NPI:1710238621
Name:CENTRO DE MEDICINA COMPLEMENTARIA Y ALTERNATIVA
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA COMPLEMENTARIA Y ALTERNATIVA
Other - Org Name:CMC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-202-6822
Mailing Address - Street 1:PO BOX 334614
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-4614
Mailing Address - Country:US
Mailing Address - Phone:787-202-6822
Mailing Address - Fax:
Practice Address - Street 1:UNION ST # 83
Practice Address - Street 2:GALERIAS PONCENAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-284-6261
Practice Address - Fax:787-284-6261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3316103T00000X
PR777171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty