Organization
LA VIDA MEDICAL GROUP HATILLO CORP
Active
Other names
LOS ANGELES MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANA I MATOS (BILLING MANAGER)
(787) 880-2363
Entity
Organization
Contact information
Practice address
549 CALLE DEL MAR, SUITE 302, HATILLO, PR 00659-2869
(787) 880-2363
(787) 881-4312
Mailing address
549 CALLE DEL MAR, SUITE 302, HATILLO, PR 00659-2869
(787) 880-2363
(787) 881-4312
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208D00000X
General Practice Physician
13836
PR
213E00000X
Podiatrist
000085
PR
261QR0206X
Mammography Clinic/Center
—
—
Other
Enumeration date
06/27/2007
Last updated
05/16/2008
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