Provider Demographics
NPI:1124327457
Name:MEDCITAS CORP
Entity type:Organization
Organization Name:MEDCITAS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRUNILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-215-9585
Mailing Address - Street 1:AVE SAN CLAUDIO 406 URB SAGRADO CORAZON
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-215-9585
Mailing Address - Fax:787-292-0489
Practice Address - Street 1:406 CALLE SAN CLAUDIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4117
Practice Address - Country:US
Practice Address - Phone:787-215-9585
Practice Address - Fax:787-292-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRVTE4475347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle