Provider Demographics
NPI:1730494493
Name:M.R. MEDICAL, P.S.C.
Entity Type:Organization
Organization Name:M.R. MEDICAL, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-268-3192
Mailing Address - Street 1:1801 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1900
Mailing Address - Country:US
Mailing Address - Phone:787-268-3192
Mailing Address - Fax:787-268-3191
Practice Address - Street 1:1801 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1900
Practice Address - Country:US
Practice Address - Phone:787-268-3192
Practice Address - Fax:787-268-3191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty