Provider Demographics
NPI:1588071005
Name:AMELIA MEDICAL OFFICE
Entity type:Organization
Organization Name:AMELIA MEDICAL OFFICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:ESTELA
Authorized Official - Last Name:SANCHEZ DE LOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-273-8270
Mailing Address - Street 1:965 S.E. 27TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2706
Mailing Address - Country:US
Mailing Address - Phone:787-273-8270
Mailing Address - Fax:939-338-9741
Practice Address - Street 1:965 S.E. 27TH STREET
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2706
Practice Address - Country:US
Practice Address - Phone:787-273-8270
Practice Address - Fax:939-338-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10862208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10862Medicare UPIN
G37209Medicare PIN