Provider Demographics
NPI:1881155976
Name:CLINICA MEDICINA PREVENTIVA C.P.
Entity type:Organization
Organization Name:CLINICA MEDICINA PREVENTIVA C.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAZQUEZ OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-728-6093
Mailing Address - Street 1:PO BOX 367083
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-7083
Mailing Address - Country:US
Mailing Address - Phone:787-728-6093
Mailing Address - Fax:787-230-0988
Practice Address - Street 1:1801 AVE PONCE DE LEON
Practice Address - Street 2:SANTURCE MEDICAL MALL SUITE 101 B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-728-6093
Practice Address - Fax:787-230-0988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty