Provider Demographics
NPI:1972724441
Name:WESTERN MEDICAL ALLIANCE CO
Entity type:Organization
Organization Name:WESTERN MEDICAL ALLIANCE CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-833-3695
Mailing Address - Street 1:PO BOX 1416
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1416
Mailing Address - Country:US
Mailing Address - Phone:787-833-3695
Mailing Address - Fax:787-833-3695
Practice Address - Street 1:410 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1560
Practice Address - Country:US
Practice Address - Phone:787-833-3695
Practice Address - Fax:787-833-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84843Medicare ID - Type UnspecifiedPROVIDER NUN