Provider Demographics
NPI:1285009613
Name:ANGELORUM, INC.
Entity Type:Organization
Organization Name:ANGELORUM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO /DIRECTOR MEDIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-316-1212
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0419
Mailing Address - Country:US
Mailing Address - Phone:787-270-3330
Mailing Address - Fax:787-915-7594
Practice Address - Street 1:CARR 693 KM 13.8
Practice Address - Street 2:SUITE 171 BO BRENAS
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-3330
Practice Address - Fax:787-915-7594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9663261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1376577924Medicare NSC