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General NPI Number Information
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NPI Number | 1114104809
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Entity Type | Organization
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Legal Business Name | INTITUTO PUERTORRIQUENO MED INTEGRAL
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 01/25/2008
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Provider Practice Location Address
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Address Line | AVE ITURREGUI MO 1
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City | CAROLINA
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State | PR
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Zip | 00982
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Country | US
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Telephone | 787-768-3882
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Fax | 787-769-2062
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Provider Business Mailing Address
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Address Line | MD 2 CALLE 402 URB COUNTRY CLUB
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City | CAROLINA
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State | PR
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Zip | 00982
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Country | US
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Telephone | 787-768-3882
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Fax | 787-769-2062
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GILBERTO OLIVERAS
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Credential |
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Telephone | 787-768-3882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 9387
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License Number State | PR
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