Individual
DR. CARMEN LUISA MEDIAVILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 AVE. F.D. ROOSEVELT, ,CLINICA LAS AMERICAS SUITE 203, HATO REY, PR 00918
(787) 783-4423
(787) 781-5342
Mailing address
400 AVE. F.D. ROOSEVELT, ,CLINICA LAS AMERICAS SUITE 203, HATO REY, PR 00918
(787) 783-4423
(787) 781-5342
Taxonomy
Speciality
Code
Description
License number
State
261QM3000X
Medically Fragile Infants and Children Day Care
Primary
004984
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004984
LICENSE MD,PR
PR
01
—
98980
PROVIDER #TRIPLE-S MANAGE
PR
Enumeration date
06/12/2007
Last updated
07/08/2007
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