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General NPI Number Information
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NPI Number | 1669934717
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Entity Type | Organization
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Legal Business Name | ISLAND PHYSICIAN MANAGEMENT, LLC
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 35 CALLE JUAN C BORBON STE 67-143
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City | GUAYNABO
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State | PR
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Zip | 00969-5374
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Country | US
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Telephone | 787-647-0816
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Fax |
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Provider Business Mailing Address
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Address Line | 35 CALLE JUAN C BORBON STE 67-143
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City | GUAYNABO
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State | PR
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Zip | 00969-5374
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Country | US
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Telephone | 787-647-0816
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILFREDO ROSADO SANTIAGO
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Credential |
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Telephone | 787-647-0816
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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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