Carmen Luisa Mediavilla, M.D.

Primary specialty

Medically Fragile Infants and Children Day CareTaxonomy code 261QM3000X

License

004984 Issued in PR

Practice address

400 Ave. F.D. Roosevelt
,Clinica Las Americas Suite 203
Hato Rey, PR 00918

Phone

(787) 783-4423

Fax

(787) 781-5342

NPI assigned

Jun 12, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407050776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 AVE. F.D. ROOSEVELT",
            "address_2": ",CLINICA LAS AMERICAS SUITE 203",
            "city": "HATO REY",
            "state": "PR",
            "postal_code": "00918",
            "telephone_number": "787-783-4423",
            "fax_number": "787-781-5342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 AVE. F.D. ROOSEVELT",
            "address_2": ",CLINICA LAS AMERICAS SUITE 203",
            "city": "HATO REY",
            "state": "PR",
            "postal_code": "00918",
            "telephone_number": "787-783-4423",
            "fax_number": "787-781-5342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDIAVILLA",
        "first_name": "CARMEN",
        "middle_name": "LUISA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medically Fragile Infants and Children Day Care",
            "state": "PR",
            "license": "004984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE MD,PR",
            "identifier": "004984",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER #TRIPLE-S MANAGE",
            "identifier": "98980",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yadira Massari-Perez, RPH
• Julio M Matias, DPM
• Geraldine Mayo Alburquerque, RDN
• Me Medical Office CSP
• Medhealth
• Gisselle Medina Crespo, MSW
• Tomas Medina
• Enid Maria Melendez, REGISTERED DIETITIAN
• Ilia Melendez, RPH
• Maria De Lourdes Melendez, RN

• Medically Fragile Infants and Children Day Care in Hato Rey, PR
• Providers in Hato Rey, PR by specialty
• Medically Fragile Infants and Children Day Care in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.