Provider Demographics
NPI:1497317069
Name:INDEPENDENT PRACTICE NETWORK, LLC.
Entity Type:Organization
Organization Name:INDEPENDENT PRACTICE NETWORK, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUIDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-892-8092
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0080
Mailing Address - Country:US
Mailing Address - Phone:787-892-8092
Mailing Address - Fax:
Practice Address - Street 1:102 CALLE DR VEVE
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4132
Practice Address - Country:US
Practice Address - Phone:787-892-8092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT PRACTICE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization