MEDICARE: INSTITUTO MEDICO DEL DOLOR Y MEDICINA COMPLEMENTARIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	165, 10076	PR

General Provider Information

NPI Number	:	1790984474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTO MEDICO DEL DOLOR Y MEDICINA COMPLEMENTARIA

Provider Business Mailing Address
First Line	:	652 MUNOZ RIVERA AVE.
Second Line	:	MONTE MALL BLDG SUITE 2070
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4149
Country	:	US
Telephone Number	:	787-293-3223
Fax Number	:	787-759-3000

Provider Business Practice Location Address
First Line	:	652 MUNOZ RIVERA AVE.
Second Line	:	MONTE MALL BLDG SUITE 2070
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4149
Country	:	US
Telephone Number	:	787-293-3223
Fax Number	:	787-759-3000

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAMUL E TORRES CASTRO
Credential	:	M.D.
Telephone Number	:	787-296-3223

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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