# MEDICINA AUDAZ, INC.

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

## Provider details

- **NPI number:** 1750434346
- **Authorized official:** DR. LUIS ACEVEDO M.D. (PRESIDENT)
- **Authorized official phone:** (787) 819-1215

## Contact information

- **Practice address:** AVE. KENNEDY \# 18 CARR. \# 2 KM 141.10, HOSPITAL BUEN SAMARITANO (1ST FLOOR), AGUADILLA, PR 00603-0000
- **Practice address phone:** (787) 819-1215
- **Practice address fax:** (787) 819-1215
- **Mailing address:** PO BOX 1868, VICTORIA STATION, AGUADILLA, PR 00605-1868
- **Mailing address phone:** (787) 819-1215
- **Mailing address fax:** (787) 819-1215

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 125152 | PR | Yes |

## Other

- **Enumeration date:** 01/19/2007
- **Last updated:** 08/22/2020