Provider Demographics
NPI:1780800730
Name:BELLA VISTA MEDICINE OFFICE P S C
Entity type:Organization
Organization Name:BELLA VISTA MEDICINE OFFICE P S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-842-6542
Mailing Address - Street 1:URB. VILLA ESPERANZA C2 #30
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4063
Mailing Address - Country:US
Mailing Address - Phone:787-842-6542
Mailing Address - Fax:787-842-6542
Practice Address - Street 1:ST. NEVADA #11 URB BELLA VISTA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-842-6542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10517261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG37208Medicare UPIN