Provider Demographics
NPI:1356972111
Name:MI MEDICO PRIMARIO, LLC
Entity type:Organization
Organization Name:MI MEDICO PRIMARIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-403-6333
Mailing Address - Street 1:410 AVE GENERAL VALERO STE 307
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3982
Mailing Address - Country:US
Mailing Address - Phone:787-863-4058
Mailing Address - Fax:787-801-7344
Practice Address - Street 1:410 AVE GENERAL VALERO STE 307
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3982
Practice Address - Country:US
Practice Address - Phone:787-863-4058
Practice Address - Fax:787-801-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service