Provider Demographics
NPI:1699491050
Name:MEDIPREV
Entity type:Organization
Organization Name:MEDIPREV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-412-3346
Mailing Address - Street 1:DG15 CALLE BABILONIA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-5342
Mailing Address - Country:US
Mailing Address - Phone:787-797-9999
Mailing Address - Fax:
Practice Address - Street 1:CENTRO COMERCIAL CIUDAD JARDIN
Practice Address - Street 2:LOCAL 1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-412-3346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR431130OtherBUSINESS REGISTER