Provider Demographics
NPI:1396504031
Name:MEDLAW LLC
Entity type:Organization
Organization Name:MEDLAW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-284-6261
Mailing Address - Street 1:PO BOX 334614
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-4614
Mailing Address - Country:US
Mailing Address - Phone:787-284-6261
Mailing Address - Fax:
Practice Address - Street 1:GALERIAS PONCENAS
Practice Address - Street 2:CALLE UNION NUM 83
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-284-6261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty