Provider Demographics
NPI:1053926451
Name:LOS PINOS MEDICAL CENTER LLC
Entity type:Organization
Organization Name:LOS PINOS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA RIESTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-315-8801
Mailing Address - Street 1:URB SABANERA
Mailing Address - Street 2:CAMINO DE AGUIRRE #542
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-315-8801
Mailing Address - Fax:844-858-3125
Practice Address - Street 1:BO SANTANA ZONA INDUSTRIAL
Practice Address - Street 2:CARR #2 KM 67.7
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:939-644-7043
Practice Address - Fax:844-858-3125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty