1922203629 NPI number — MRS. CARMEN BRITO MEDINA M.D.

Table of content: MRS. CARMEN BRITO MEDINA M.D. (NPI 1922203629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922203629 NPI number — MRS. CARMEN BRITO MEDINA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRITO MEDINA
Provider First Name:
CARMEN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRITO
Provider Other First Name:
CARMEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1922203629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-798-4592
Provider Business Mailing Address Fax Number:
787-798-8237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EDIFICIO MEDICO SANTA CRUZ #73
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-4592
Provider Business Practice Location Address Fax Number:
787-798-8237
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  17028 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 17028 . This is a "PUERTO RICO MEDICAL LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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