Healthcare Provider Details

I. General information

NPI: 1750428884
Provider Name (Legal Business Name): INDEPENDENT MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. PRINCIPAL G-5 URB. BARALT
FAJARDO PR
00738
US

IV. Provider business mailing address

PO BOX 1311
FAJARDO PR
00738-1311
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-2267
  • Fax:
Mailing address:
  • Phone: 787-889-2267
  • Fax: 787-889-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11863
License Number StatePR

VIII. Authorized Official

Name: LUIS ARMANDO ARRAUT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-889-2267