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General NPI Number Information
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NPI Number | 1881155976
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Entity Type | Organization
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Legal Business Name | CLINICA MEDICINA PREVENTIVA C.P.
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 03/29/2019
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Provider Practice Location Address
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Address Line | 1801 AVE PONCE DE LEON SANTURCE MEDICAL MALL SUITE 101 B
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City | SAN JUAN
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State | PR
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Zip | 00909
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Country | US
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Telephone | 787-728-6093
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Fax | 787-230-0988
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Provider Business Mailing Address
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Address Line | PO BOX 367083
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City | SAN JUAN
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State | PR
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Zip | 00936-7083
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Country | US
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Telephone | 787-728-6093
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Fax | 787-230-0988
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOURDES M VAZQUEZ OTERO
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Credential | MD
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Telephone | 787-728-6093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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