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General NPI Number Information
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NPI Number | 1972806115
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Entity Type | Organization
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Legal Business Name | MEDIKO RED ALIADO CORP
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Dates
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Enumeration Date | 12/09/2010
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | CALLE MATADERO SUR # 3
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City | GURABO
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State | PR
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Zip | 00778-7589
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Country | US
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Telephone | 787-653-5353
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Fax | 787-653-5364
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Provider Business Mailing Address
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Address Line | PO BOX 7589 CALLE MATADERO SUR # 3
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City | CAGUAS
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State | PR
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Zip | 00725-7589
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Country | US
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Telephone | 787-653-5353
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Fax | 787-653-5364
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Authorized Official
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Title or Position | GESTORA
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Name | MISS CARMEN SANTIAGO
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Credential |
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Telephone | 787-653-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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