Organization Name: | CONSULTORIO MEDICO MLO INC |
NPI Number: | 1538458161 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARIA LOURDES ORTIZ DE LA CRUZ (ADMINISTRADORA) |
Mailing Address: | Calle Marginal Carr 129 Sector Denton Arecibo |
State: | PR US |
Postal Code: | 00613 |
Phone Number: | 7876501363 |
Fax Number: | 7876501363 |
NPI Enumeration Date: | 04/05/2011 |
NPI Last Update Date: | 04/05/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |