Provider Demographics
NPI:1487801106
Name:MMR INSTITUTO DE MEDICINA DE FAMILLIA DEL OESTE
Entity type:Organization
Organization Name:MMR INSTITUTO DE MEDICINA DE FAMILLIA DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIASIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-896-9000
Mailing Address - Street 1:PMB 336
Mailing Address - Street 2:PO BOX 7999
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681
Mailing Address - Country:US
Mailing Address - Phone:787-896-9000
Mailing Address - Fax:787-896-9000
Practice Address - Street 1:2 CALLE PROVIDENCIA BARRERO
Practice Address - Street 2:URB LOS ALAMOS
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2179
Practice Address - Country:US
Practice Address - Phone:787-896-9000
Practice Address - Fax:787-896-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81110Medicare PIN