Provider Demographics
NPI:1952956765
Name:MEDICINA PREVENTIVA DEL OESTE
Entity Type:Organization
Organization Name:MEDICINA PREVENTIVA DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SACHA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GONZALEZ AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-455-0321
Mailing Address - Street 1:1040 CALLE B
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7634
Mailing Address - Country:US
Mailing Address - Phone:787-455-0321
Mailing Address - Fax:
Practice Address - Street 1:60 N POST CENTER OFFICE 207
Practice Address - Street 2:CALLE RAMON E BETANCES
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-7634
Practice Address - Country:US
Practice Address - Phone:787-455-0321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty