Healthcare Provider Details

I. General information

NPI: 1467655522
Provider Name (Legal Business Name): IASMEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB ATENAS MARGINAL ELLITO VELEZ B 47
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 51962
TOA BAJA PR
00950-1962
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-6572
  • Fax: 787-884-6572
Mailing address:
  • Phone: 787-884-6572
  • Fax: 787-884-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number10514
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. IGNACIO ACEVEDO
Title or Position: FAMILY MEDICINE
Credential: MD
Phone: 787-884-6572