Provider Demographics
NPI:1992033138
Name:CLINICA CONTROL DE PESO DE HORMIGUEROS, INC.
Entity Type:Organization
Organization Name:CLINICA CONTROL DE PESO DE HORMIGUEROS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIA
Authorized Official - Middle Name:IVETTE
Authorized Official - Last Name:VARONA CANTELLOPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-849-0099
Mailing Address - Street 1:PO BOX 1381
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1381
Mailing Address - Country:US
Mailing Address - Phone:787-849-0099
Mailing Address - Fax:787-849-0099
Practice Address - Street 1:14Y 15 SAN ANTONIO
Practice Address - Street 2:HORMIGUEROS PLAZA SUITE 4
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-849-0099
Practice Address - Fax:787-849-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12660208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty