Provider Demographics
NPI:1457421265
Name:MEDICAL FAMILY CENTER
Entity Type:Organization
Organization Name:MEDICAL FAMILY CENTER
Other - Org Name:CENTRO SERVICIOS AMBULATORIOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ BENABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-714-0410
Mailing Address - Street 1:PO BOX 1862
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE EL JIBARO BO BAYAMON
Practice Address - Street 2:PARGUE INDUSTRIAL
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-714-0410
Practice Address - Fax:787-714-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17F19773336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2086537OtherPK