Provider Demographics
NPI:1306549209
Name:MEDICINA PRIMARIA BUENA VISTA LLC.
Entity type:Organization
Organization Name:MEDICINA PRIMARIA BUENA VISTA LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:LIZ
Authorized Official - Last Name:COLON MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-903-1254
Mailing Address - Street 1:3269 CALLE MONTE LA MINA
Mailing Address - Street 2:URB. PRDERAS DEL RIO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9132
Mailing Address - Country:US
Mailing Address - Phone:787-797-0754
Mailing Address - Fax:787-797-0754
Practice Address - Street 1:CARR. 167 KM 15.1
Practice Address - Street 2:BARRIO BUENA VISTA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-797-0754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty