Healthcare Provider Details

I. General information

NPI: 1699079863
Provider Name (Legal Business Name): ALTERNATIVA MODERNA DE MEDICINA ESPECIALIZADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 26 KM 4.2 HATO TEJAS
BAYAMON PR
00924
US

IV. Provider business mailing address

877 AVE CAMPO RICO
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 787-701-4938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LILIA OTERO
Title or Position: OWNER
Credential:
Phone: 787-701-4938