Provider Demographics
NPI:1194936104
Name:INSTITUTO MEDICINA INTEGRAL
Entity type:Organization
Organization Name:INSTITUTO MEDICINA INTEGRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:
Authorized Official - Last Name:MELENDEZ ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-769-7525
Mailing Address - Street 1:STREET 266 PB 30
Mailing Address - Street 2:3RA EXT. COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-769-7525
Mailing Address - Fax:787-769-2428
Practice Address - Street 1:CALLE 266 BLOQUE PB 30
Practice Address - Street 2:AVE. EL COMANDANTE 3RA EXT. COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-769-7525
Practice Address - Fax:787-769-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10501208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0082900Medicare ID - Type UnspecifiedPROVEEDOR NUMBER
PRMEDICAREMedicare UPIN