Healthcare Provider Details

I. General information

NPI: 1093023715
Provider Name (Legal Business Name): ALTERNATIVA MODERNA DE MEDICINA ESPECIALIZADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARGINAL MARTINEZ NADAL 559 MARGINAL HILL SIDE
GUAYNABO PR
00920
US

IV. Provider business mailing address

877 CAMPO RICO AVE COUNTRY CLUB
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 TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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