Healthcare Provider Details

I. General information

NPI: 1821394123
Provider Name (Legal Business Name): IPAS DEL NORESTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

J2 CALLE 2
RIO GRANDE PR
00745-2840
US

IV. Provider business mailing address

PO BOX 1515
RIO GRANDE PR
00745-1515
US

V. Phone/Fax

Practice location:
  • Phone: 787-887-0020
  • Fax: 787-887-0020
Mailing address:
  • Phone: 787-887-0020
  • Fax: 787-887-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MS. GLORIA M ALVAREZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-887-0020