Provider Demographics
NPI:1639847007
Name:MI ALICIA LLC
Entity type:Organization
Organization Name:MI ALICIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERA OLMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-970-0708
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0212
Mailing Address - Country:US
Mailing Address - Phone:787-970-0708
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE MARGINAL KM 43.2
Practice Address - Street 2:BO ALGARROBO
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-3844
Practice Address - Country:US
Practice Address - Phone:787-970-0708
Practice Address - Fax:787-970-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncologyGroup - Multi-Specialty