=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558038471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IPAR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2021
-----------------------------------------------------
Last Update Date | 06/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ANEXO HOSPITAL METROPOLITANO DE LA MONTANA CALLE DR. ISAAC GONZALEZ
-----------------------------------------------------
City | UTUADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00641
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-248-1534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1441
-----------------------------------------------------
City | UTUADO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00641-1441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-248-1534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRADORA
-----------------------------------------------------
Name | ANGELICA MAGLEN RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-248-1534
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------