Provider Demographics
NPI:1477738516
Name:EDWIN FIGUEROA
Entity Type:Organization
Organization Name:EDWIN FIGUEROA
Other - Org Name:SERVICIOS MEDICOS PRIMARIOS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:FIGUEROA DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-286-9691
Mailing Address - Street 1:PMB 293
Mailing Address - Street 2:PO BOX 4952
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-286-9691
Mailing Address - Fax:787-747-7654
Practice Address - Street 1:URB. PARADISE CALLE CORCHADO B5
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-286-9691
Practice Address - Fax:787-747-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10013261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF30914Medicare UPIN