Provider Demographics
NPI:1013003144
Name:INSTITUTO DE ARTRITIS DEL OESTE
Entity Type:Organization
Organization Name:INSTITUTO DE ARTRITIS DEL OESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:PANCORBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-264-0818
Mailing Address - Street 1:PO BOX 3445
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-3445
Mailing Address - Country:US
Mailing Address - Phone:787-264-0818
Mailing Address - Fax:
Practice Address - Street 1:SAN GERMAN MEDICAL PLAZA, SUITE 203-205
Practice Address - Street 2:ROAD #2 KM 174
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-264-0818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15453207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H97611Medicare UPIN