Healthcare Provider Details

I. General information

NPI: 1194465716
Provider Name (Legal Business Name): LA MEDICA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. PONTEZUELA L583
CAROLINA PR
00983
US

IV. Provider business mailing address

PO BOX 8773
CAROLINA PR
00988-8773
US

V. Phone/Fax

Practice location:
  • Phone: 939-845-7224
  • Fax:
Mailing address:
  • Phone: 939-845-7224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MONICA MOLINA-SERRANO
Title or Position: OWNER/ADMINISTRATOR
Credential: MD
Phone: 787-462-6948