Healthcare Provider Details

I. General information

NPI: 1811305204
Provider Name (Legal Business Name): CONSULTORIO DE MEDICINA INTERNA CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 111 KM 22.8
SAN SEBASTIAN PR
00685
US

IV. Provider business mailing address

PO BOX 1561
SAN SEBASTIAN PR
00685
US

V. Phone/Fax

Practice location:
  • Phone: 787-280-3398
  • Fax: 787-896-0230
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number10451
License Number StatePR

VIII. Authorized Official

Name: DR. CARLOS RAMOS
Title or Position: PRESIDENT
Credential:
Phone: 787-280-3398