Provider Demographics
NPI:1114104809
Name:INTITUTO PUERTORRIQUENO MED INTEGRAL
Entity Type:Organization
Organization Name:INTITUTO PUERTORRIQUENO MED INTEGRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-768-3882
Mailing Address - Street 1:MD 2 CALLE 402
Mailing Address - Street 2:URB COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-768-3882
Mailing Address - Fax:787-769-2062
Practice Address - Street 1:AVE ITURREGUI MO 1
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-768-3882
Practice Address - Fax:787-769-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9387261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service