Provider Demographics
NPI:1225390123
Name:INTELLIMED, PSC
Entity Type:Organization
Organization Name:INTELLIMED, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:IRIZARRY RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-366-0517
Mailing Address - Street 1:17 CALLE CORAZON
Mailing Address - Street 2:URB MILAVILLE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5120
Mailing Address - Country:US
Mailing Address - Phone:787-366-0517
Mailing Address - Fax:787-263-6581
Practice Address - Street 1:HOSPITAL MENONITA CARR #14
Practice Address - Street 2:SUITE 307, EDIF PROFESIONAL
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-3801
Practice Address - Country:US
Practice Address - Phone:787-738-2871
Practice Address - Fax:787-263-6581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty