# CONSULTORIO MEDICO VILLA BLANCA, PSC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710325063
- **Authorized official:** DR. JORGE E ALFONSO MEDINA M.D. (CEO)
- **Authorized official phone:** (939) 325-3907

## Contact information

- **Practice address:** 10 AVE LUIS MUNOZ MARIN, VILLA BLANCA, CAGUAS, PR 00725-1922
- **Practice address phone:** (939) 325-3907
- **Practice address fax:** (787) 744-0280
- **Mailing address:** AVE 200 RAFAEL CORDERO, SUIT 140 PMB 494, CAGUAS, PR 00726-9998
- **Mailing address phone:** (939) 325-3907
- **Mailing address fax:** (787) 744-0280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/10/2013
- **Last updated:** 01/05/2015