Provider Demographics
NPI:1912591041
Name:ON SITE PREVENTIVE MEDICINE CSP
Entity Type:Organization
Organization Name:ON SITE PREVENTIVE MEDICINE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIMO
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLONDET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-409-5869
Mailing Address - Street 1:400 AVE FD ROOSEVELT STE 409
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 AVE FD ROOSEVELT STE 409
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2163
Practice Address - Country:US
Practice Address - Phone:787-903-6100
Practice Address - Fax:787-273-0935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332900000XSuppliersNon-Pharmacy Dispensing Site
No333300000XSuppliersEmergency Response System Companies