Provider Demographics
NPI:1235543190
Name:MONDOCANO INTERNAL MEDICINE PSC
Entity Type:Organization
Organization Name:MONDOCANO INTERNAL MEDICINE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMUDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-721-7973
Mailing Address - Street 1:1359 CALLE LUCHETTI
Mailing Address - Street 2:APT 802
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2063
Mailing Address - Country:US
Mailing Address - Phone:787-721-7973
Mailing Address - Fax:787-721-7973
Practice Address - Street 1:CALLE WASHINGTON # 29
Practice Address - Street 2:ASHFORD MEDICAL CENTER SUITE 802
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-721-7973
Practice Address - Fax:787-721-7973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty