Provider Demographics
NPI:1710313986
Name:LA CUMBRE MEDICAL LLC
Entity Type:Organization
Organization Name:LA CUMBRE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALADINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-708-2222
Mailing Address - Street 1:CAROLINA SHOPP CTR
Mailing Address - Street 2:PO BOX 9512
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-5672
Mailing Address - Country:US
Mailing Address - Phone:787-708-2222
Mailing Address - Fax:
Practice Address - Street 1:505 EMILIANO POL AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-708-2222
Practice Address - Fax:787-720-7693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14749261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRP23156Medicare UPIN