Provider Demographics
NPI:1982393104
Name:LAJAS MEDICAL LLC
Entity Type:Organization
Organization Name:LAJAS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:C
Authorized Official - Last Name:PALMER MELLOWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-215-6056
Mailing Address - Street 1:513 VILLA FONTANA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7452
Mailing Address - Country:US
Mailing Address - Phone:787-215-6056
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE 65 DE INFANTERIA N
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-2081
Practice Address - Country:US
Practice Address - Phone:787-899-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty