Provider Demographics
NPI:1386241537
Name:SERVICIOS MEDICOS DR ALCANTARA LLC
Entity type:Organization
Organization Name:SERVICIOS MEDICOS DR ALCANTARA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD DR
Authorized Official - Prefix:DR
Authorized Official - First Name:TEMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT HILAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-615-6370
Mailing Address - Street 1:PO BOX 362204
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-2204
Mailing Address - Country:US
Mailing Address - Phone:787-763-2228
Mailing Address - Fax:787-763-2228
Practice Address - Street 1:AVE SIMON MADERA 804 VILLA PRADES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-763-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7877632228Medicaid