Provider Demographics
NPI:1376995266
Name:PUERTO RICO MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:PUERTO RICO MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-227-9680
Mailing Address - Street 1:540 CARR 169
Mailing Address - Street 2:APT 1006
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4275
Mailing Address - Country:US
Mailing Address - Phone:939-227-9680
Mailing Address - Fax:787-277-1573
Practice Address - Street 1:540 CARR 169
Practice Address - Street 2:APT 1006
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4275
Practice Address - Country:US
Practice Address - Phone:939-227-9680
Practice Address - Fax:787-277-1573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service