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General NPI Number Information
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NPI Number | 1477736098
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE INDIVIDUAL PRACTICE
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | AVE ROTARIO BO ASOMANTE CARR 115 KM 24.8
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-868-5857
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Fax | 787-868-5857
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Provider Business Mailing Address
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Address Line | PO BOX 1706
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City | AGUADA
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State | PR
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Zip | 00602-1706
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Country | US
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Telephone | 787-868-5857
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Fax | 787-868-5857
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Authorized Official
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Title or Position | FACTURADOR MEDICO
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Name | CORTES WINDALYS
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Credential |
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Telephone | 17878685857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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