Provider Demographics
NPI:1306050570
Name:NORTE MED, INC.
Entity type:Organization
Organization Name:NORTE MED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDALIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-878-4885
Mailing Address - Street 1:PO BOX 140040
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0040
Mailing Address - Country:US
Mailing Address - Phone:787-878-4885
Mailing Address - Fax:787-878-8633
Practice Address - Street 1:54 CALLE ANDRES OLIVER
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4330
Practice Address - Country:US
Practice Address - Phone:787-878-4885
Practice Address - Fax:787-878-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization