Provider Demographics
NPI:1306859541
Name:DINAMICA QUIRURGICA DEL ESTE
Entity Type:Organization
Organization Name:DINAMICA QUIRURGICA DEL ESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YNGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:LITHGOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-860-3386
Mailing Address - Street 1:PMB 265
Mailing Address - Street 2:PO BOX 70005
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-7005
Mailing Address - Country:US
Mailing Address - Phone:787-860-3386
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO MEDICO DEL ESTE
Practice Address - Street 2:AVE. GENERAL VALERO
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-7005
Practice Address - Country:US
Practice Address - Phone:787-860-3386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11335207Q00000X
PR6201208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR008-4836Medicare ID - Type Unspecified