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General NPI Number Information
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NPI Number | 1568274918
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Entity Type | Organization
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Legal Business Name | BELA-G LLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | HOSPITAL WILMA VAZQUEZ CARR 2 KM. 39.5 SUITE 109
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City | VEGA BAJA
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State | PR
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Zip | 00694-7001
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Country | US
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Telephone | 787-858-1580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2569
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City | GUAYNABO
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State | PR
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Zip | 00970-2569
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Country | US
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Telephone | 787-383-2226
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EVARISTO JAIME MEDINA CUCURELLA
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Credential | MD
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Telephone | 787-383-2226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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