Provider Demographics
NPI:1801198650
Name:CLINICAS DE MEDICINADEL NORTE CSP
Entity Type:Organization
Organization Name:CLINICAS DE MEDICINADEL NORTE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-643-4747
Mailing Address - Street 1:PO BOX 140448
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0448
Mailing Address - Country:US
Mailing Address - Phone:787-643-4747
Mailing Address - Fax:787-880-4014
Practice Address - Street 1:CARR.#2 KM 62.8 BO. CANDELARIA
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-880-4014
Practice Address - Fax:787-880-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14040261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH98825Medicare UPIN