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General NPI Number Information
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NPI Number | 1760626634
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Entity Type | Organization
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Legal Business Name | PHYMED
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | CARR 165 # KM 1.2 # 48 CITY VIEW PLAZA SUITE 115
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City | GUAYNABO
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State | PR
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Zip | 00968-8047
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Country | US
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Telephone | 787-774-0707
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Fax | 787-775-0202
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Provider Business Mailing Address
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Address Line | CARR 165 # KM SUITE 115
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City | GUAYNABO
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State | PR
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Zip | 00968-8047
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Country | US
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Telephone | 787-774-0707
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Fax | 787-775-0202
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Authorized Official
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Title or Position | INTER MEDICINE
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Name | DR. EILYN DE-JESUS
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Credential | MD
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Telephone | 787-774-0707
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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 | 15909
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 13925
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 13991
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License Number State | PR
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