Provider Demographics
NPI:1972536258
Name:ALTERNATIVA MODERNA DE MEDICINA ESPECIALIZADA INC
Entity Type:Organization
Organization Name:ALTERNATIVA MODERNA DE MEDICINA ESPECIALIZADA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-464-5050
Mailing Address - Street 1:877 CAMPO RICO AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00924
Mailing Address - Country:UM
Mailing Address - Phone:787-701-4938
Mailing Address - Fax:787-701-4790
Practice Address - Street 1:877 CAMPO RICO AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:99024
Practice Address - Country:UM
Practice Address - Phone:787-701-4938
Practice Address - Fax:787-701-4790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085189Medicare PIN