Provider Demographics
NPI:1235584624
Name:KIANA MED SERVICES INC
Entity Type:Organization
Organization Name:KIANA MED SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ OCANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-601-0739
Mailing Address - Street 1:PO BOX 8243
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8243
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE 12 NUM 4
Practice Address - Street 2:NUEVA VIDA EL TUQUE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-601-3729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18020208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1417266453OtherNPI
PRIM466AMedicare UPIN