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General NPI Number Information
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NPI Number | 1154741395
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Entity Type | Organization
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Legal Business Name | INTERMED EAST LLC
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | FONT MARTELO 123 STREET
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-852-3417
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Fax | 787-859-7861
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Provider Business Mailing Address
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Address Line | PO BOX 1197
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City | LAS PIEDRAS
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State | PR
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Zip | 00771-1197
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Country | US
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Telephone | 787-342-8201
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Fax | 787-850-7861
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Authorized Official
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Title or Position | M.D.
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Name | MISS IDIA L VELAZQUEZ
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Credential |
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Telephone | 787-342-8201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13901
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License Number State | PR
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