| Organization Name: | CLINICA MEDICINA PREVENTIVA CSP |
| NPI Number: | 1295098374 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSE G CUMBA GUERRERO (DIRECTOR) |
| Mailing Address: | Urb Palacios Del Rio Ii 763 Calle Cibuco Toa Alta |
| State: | PR US |
| Postal Code: | 009535116 |
| Phone Number: | 7873900578 |
| Fax Number: | |
| NPI Enumeration Date: | 06/22/2012 |
| NPI Last Update Date: | 06/22/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 14079 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |