Provider Demographics
NPI:1013325380
Name:MV HEALTHCARE CSP
Entity Type:Organization
Organization Name:MV HEALTHCARE CSP
Other - Org Name:MV HEALTHCARE CSP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORALES VALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-860-5140
Mailing Address - Street 1:PO BOX 1323
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1323
Mailing Address - Country:US
Mailing Address - Phone:787-860-5140
Mailing Address - Fax:787-860-5140
Practice Address - Street 1:98 CALLE GARRIDO MORALES E
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4678
Practice Address - Country:US
Practice Address - Phone:787-860-5140
Practice Address - Fax:787-860-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9455208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty