Provider Demographics
NPI:1821354721
Name:PRIMARY AND PREVENTIVE MEDICINE PSC
Entity Type:Organization
Organization Name:PRIMARY AND PREVENTIVE MEDICINE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-644-7043
Mailing Address - Street 1:PO BOX 2277
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-2277
Mailing Address - Country:US
Mailing Address - Phone:939-644-7043
Mailing Address - Fax:800-783-9548
Practice Address - Street 1:CARRETERA #2, KM 67.7, ZONA INDUSTRIAL
Practice Address - Street 2:BO. SANTANA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:939-644-7043
Practice Address - Fax:800-783-9548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1429133V00000X
PR17467208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty