Provider Demographics
NPI:1477736098
Name:INTERNAL MEDICINE INDIVIDUAL PRACTICE
Entity Type:Organization
Organization Name:INTERNAL MEDICINE INDIVIDUAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACTURADOR MEDICO
Authorized Official - Prefix:
Authorized Official - First Name:CORTES
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDALYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1787-868-5857
Mailing Address - Street 1:PO BOX 1706
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1706
Mailing Address - Country:US
Mailing Address - Phone:787-868-5857
Mailing Address - Fax:787-868-5857
Practice Address - Street 1:AVE ROTARIO BO ASOMANTE CARR 115 KM 24.8
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-5857
Practice Address - Fax:787-868-5857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023065Medicare PIN
PRI32371Medicare UPIN