Provider Demographics
NPI:1740647197
Name:INSTITUTO DE MEDICINA DE FAMILIA DE LA MONTANA
Entity type:Organization
Organization Name:INSTITUTO DE MEDICINA DE FAMILIA DE LA MONTANA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-857-8383
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-0519
Mailing Address - Country:US
Mailing Address - Phone:787-857-8383
Mailing Address - Fax:787-857-4848
Practice Address - Street 1:CARR 152 KM 2.3
Practice Address - Street 2:BO. QUEBRADILLAS
Practice Address - City:BARRRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:PR
Practice Address - Country:UM
Practice Address - Phone:787-857-8383
Practice Address - Fax:787-857-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14324261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service