Provider Demographics
NPI:1235402520
Name:INSTITUTO RENAL DE SAN JUAN, LLC
Entity Type:Organization
Organization Name:INSTITUTO RENAL DE SAN JUAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-726-7008
Mailing Address - Street 1:PO BOX 19405
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1405
Mailing Address - Country:US
Mailing Address - Phone:787-723-7008
Mailing Address - Fax:787-726-7083
Practice Address - Street 1:611 CALLE PAVIA
Practice Address - Street 2:OFICINA 214
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2239
Practice Address - Country:US
Practice Address - Phone:787-726-7008
Practice Address - Fax:787-726-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty