MEDICARE: NATURAL MEDICINE OF PR, CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	011797	PR

General Provider Information

NPI Number	:	1881910834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURAL MEDICINE OF PR, CORP.

Provider Business Mailing Address
First Line	:	310 AVE DE DIEGO
Second Line	:	SUITE 301
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1712
Country	:	US
Telephone Number	:	866-972-1646
Fax Number	:	866-972-1647

Provider Business Practice Location Address
First Line	:	310 AVE DE DIEGO
Second Line	:	SUITE 301
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1712
Country	:	US
Telephone Number	:	866-972-1646
Fax Number	:	866-972-1647

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KENNETH CINTRON
Credential	:	M.D.
Telephone Number	:	866-972-1646

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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