Provider Demographics
NPI:1093059685
Name:MESOMED, PSC
Entity Type:Organization
Organization Name:MESOMED, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MMEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDOLFO
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-786-7014
Mailing Address - Street 1:AL17 CALLE 30
Mailing Address - Street 2:SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AL17 CALLE 30
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4706
Practice Address - Country:US
Practice Address - Phone:787-786-7014
Practice Address - Fax:787-740-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty