Provider Demographics
NPI:1023027901
Name:MADELINE POVENTUD MARQUEZ
Entity type:Organization
Organization Name:MADELINE POVENTUD MARQUEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIA
Authorized Official - Prefix:MISS
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:POVENTUD MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-252-5086
Mailing Address - Street 1:P O BOX 915
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:787-252-5086
Practice Address - Street 1:BO NARANJO CARR2
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-252-5086
Practice Address - Fax:787-252-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC-AMB-2743416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR890395OtherMMM
PR6904OtherAMERICAN HEALTH MEDICARE
PR50020OtherPMC
PR890395OtherMMM
PR=========OtherMCS REFORMA
PR890395OtherMMM