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General NPI Number Information
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NPI Number | 1710325063
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Entity Type | Organization
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Legal Business Name | CONSULTORIO MEDICO VILLA BLANCA, PSC
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 01/05/2015
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Provider Practice Location Address
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Address Line | 10 AVE LUIS MUNOZ MARIN VILLA BLANCA
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City | CAGUAS
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State | PR
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Zip | 00725-1922
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Country | US
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Telephone | 939-325-3907
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Fax | 787-744-0280
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Provider Business Mailing Address
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Address Line | AVE 200 RAFAEL CORDERO SUIT 140 PMB 494
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City | CAGUAS
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State | PR
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Zip | 00726-9998
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Country | US
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Telephone | 939-325-3907
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Fax | 787-744-0280
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Authorized Official
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Title or Position | CEO
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Name | DR. JORGE E ALFONSO MEDINA
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Credential | M.D.
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Telephone | 939-325-3907
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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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