Provider Demographics
NPI:1104254150
Name:ISLAND MEDICAL GROUP
Entity type:Organization
Organization Name:ISLAND MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-306-8356
Mailing Address - Street 1:PO BOX 16327
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6327
Mailing Address - Country:US
Mailing Address - Phone:787-306-8356
Mailing Address - Fax:
Practice Address - Street 1:CALLE MARGINAL
Practice Address - Street 2:E7
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-2536
Practice Address - Country:US
Practice Address - Phone:787-306-8356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty