Provider Demographics
NPI:1457416281
Name:CLINICA FAMILIAR DR EDWIN OLMEDA CSP
Entity type:Organization
Organization Name:CLINICA FAMILIAR DR EDWIN OLMEDA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLMEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-820-6182
Mailing Address - Street 1:119 CALLE VIDAL FELIX
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1818
Mailing Address - Country:US
Mailing Address - Phone:787-820-6182
Mailing Address - Fax:787-898-1993
Practice Address - Street 1:119 CALLE VIDAL FELIX
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1818
Practice Address - Country:US
Practice Address - Phone:787-820-6182
Practice Address - Fax:787-898-1993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE78432Medicare UPIN
PR0085245Medicare PIN