Healthcare Provider Details

I. General information

NPI: 1639847007
Provider Name (Legal Business Name): MI ALICIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CALLE MARGINAL KM 43.2 BO ALGARROBO
VEGA BAJA PR
00693-3844
US

IV. Provider business mailing address

PO BOX 212
BARCELONETA PR
00617-0212
US

V. Phone/Fax

Practice location:
  • Phone: 787-970-0708
  • Fax: 787-970-1105
Mailing address:
  • Phone: 787-970-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE A RIVERA OLMO
Title or Position: MD & PRESIDENT
Credential: MD
Phone: 787-970-0708