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General NPI Number Information
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NPI Number | 1356496665
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Entity Type | Organization
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Legal Business Name | EAST WEST MEDICAL CENTER PSC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 570 CALLE CESAR GONZALEZ URB BALDRICH
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City | SAN JUAN
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State | PR
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Zip | 00918-3738
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Country | US
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Telephone | 787-754-1535
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Fax | 787-754-1535
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Provider Business Mailing Address
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Address Line | 138 AVE WINSTON CHURCHILL PMB-362
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City | SAN JUAN
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State | PR
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Zip | 00926-6013
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Country | US
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Telephone | 787-754-1535
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Fax | 787-754-1535
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Authorized Official
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Title or Position | DIRECTOR
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Name | DWEEPKUMAR I BANGDIWALA
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Credential | M.D.
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Telephone | 787-754-1535
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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 | 6524
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License Number State | PR
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