Provider Demographics
NPI:1265174981
Name:WEST MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:WEST MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY CARE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:NORBERTO
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-639-8869
Mailing Address - Street 1:HC 2 BOX 1742
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-9300
Mailing Address - Country:US
Mailing Address - Phone:787-639-8869
Mailing Address - Fax:
Practice Address - Street 1:151 CALLE CANDELARIA ESQUINA TETUAN
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:939-344-6542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care