Provider Demographics
NPI:1942737432
Name:MEDIKO MEDICINA PRIMARIA CORP
Entity Type:Organization
Organization Name:MEDIKO MEDICINA PRIMARIA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-653-5353
Mailing Address - Street 1:PO BOX 7589
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-7589
Mailing Address - Country:US
Mailing Address - Phone:787-653-5353
Mailing Address - Fax:787-653-5364
Practice Address - Street 1:3 CALLE MATADERO SUR
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-653-5353
Practice Address - Fax:787-653-5364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-16
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Single Specialty