Healthcare Provider Details

I. General information

NPI: 1841400637
Provider Name (Legal Business Name): INTEGRATIVE DIABETIC RESEARCH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D12 CALLE ROMA VILLA CAPARRA
GUAYNABO PR
00966-1725
US

IV. Provider business mailing address

D12 CALLE ROMA VILLA CAPARRA
GUAYNABO PR
00966-1725
US

V. Phone/Fax

Practice location:
  • Phone: 787-608-9857
  • Fax:
Mailing address:
  • Phone: 787-608-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMON MENDEZ
Title or Position: PRESIDENTE
Credential:
Phone: 787-607-9857