Provider Demographics
NPI:1053616250
Name:MEDICINA INTERNA AMBULATORIA Y HOSPITALARIA
Entity type:Organization
Organization Name:MEDICINA INTERNA AMBULATORIA Y HOSPITALARIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICINA INTERNA
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-892-2626
Mailing Address - Street 1:URB.PARAISO SERENIDAD 201
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-0000
Mailing Address - Country:US
Mailing Address - Phone:787-892-2626
Mailing Address - Fax:787-892-2626
Practice Address - Street 1:AVE.UNIVERSIDAD INTERAMERICANA #18
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-0000
Practice Address - Country:US
Practice Address - Phone:787-892-2626
Practice Address - Fax:787-892-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021580Medicare PIN