Provider Demographics
NPI:1285440701
Name:CLINICA MEDICA PEDIATRICA, LLC
Entity type:Organization
Organization Name:CLINICA MEDICA PEDIATRICA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWE SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:MINELA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLON SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-852-1514
Mailing Address - Street 1:10-E AVE. FONT MARTELO
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-852-1514
Mailing Address - Fax:
Practice Address - Street 1:10-E AVE. FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00971
Practice Address - Country:US
Practice Address - Phone:787-852-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care