Provider Demographics
NPI:1205204823
Name:RENAL IPA OF PR LLC
Entity Type:Organization
Organization Name:RENAL IPA OF PR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-215-6056
Mailing Address - Street 1:27 CALLE DR NELSON PEREA STE 104
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4950
Mailing Address - Country:US
Mailing Address - Phone:787-215-6056
Mailing Address - Fax:
Practice Address - Street 1:27 CALLE DR NELSON PEREA STE 104
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4950
Practice Address - Country:US
Practice Address - Phone:787-215-6056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty