Provider Demographics
NPI:1750434346
Name:MEDICINA AUDAZ, INC.
Entity type:Organization
Organization Name:MEDICINA AUDAZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-819-1215
Mailing Address - Street 1:PO BOX 1868
Mailing Address - Street 2:VICTORIA STATION
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-1868
Mailing Address - Country:US
Mailing Address - Phone:787-819-1215
Mailing Address - Fax:787-819-1215
Practice Address - Street 1:AVE. KENNEDY # 18 CARR. # 2 KM 141.10
Practice Address - Street 2:HOSPITAL BUEN SAMARITANO (1ST FLOOR)
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0000
Practice Address - Country:US
Practice Address - Phone:787-819-1215
Practice Address - Fax:787-819-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR125152261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center