Healthcare Provider Details

I. General information

NPI: 1811078926
Provider Name (Legal Business Name): IMCS HOLDINGS OF PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870-A SAN ANTONIO STREET PDA 26
SAN JUAN PR
00909
US

IV. Provider business mailing address

1870-A SAN ANTONIO STREET PDA 26
SAN JUAN PR
00909
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-9620
  • Fax: 787-726-1720
Mailing address:
  • Phone: 787-726-9620
  • Fax: 787-726-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. NELIDA GOMEZ
Title or Position: PRESIDENT
Credential: PHDC, CPUM, CPUR
Phone: 787-726-9620