Provider Demographics
NPI:1992030431
Name:MEDI EX CSP
Entity Type:Organization
Organization Name:MEDI EX CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDUJAR
Authorized Official - Suffix:
Authorized Official - Credentials:7876460202
Authorized Official - Phone:787-646-0202
Mailing Address - Street 1:ARZUAGA 112
Mailing Address - Street 2:SUITE 605
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3316
Mailing Address - Country:US
Mailing Address - Phone:787-646-0202
Mailing Address - Fax:787-763-0200
Practice Address - Street 1:ARZUAGA 112
Practice Address - Street 2:SUITE 605
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3316
Practice Address - Country:US
Practice Address - Phone:787-646-0202
Practice Address - Fax:787-763-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization