Provider Demographics
NPI:1568430585
Name:DE SOTO INTERNAL MEDICINE SERVICES, PSC
Entity Type:Organization
Organization Name:DE SOTO INTERNAL MEDICINE SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARBALLO DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-518-0104
Mailing Address - Street 1:185 CANDELERO DR APT 608
Mailing Address - Street 2:FAIRLAKES VILLAGE
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-6133
Mailing Address - Country:US
Mailing Address - Phone:787-518-0104
Mailing Address - Fax:
Practice Address - Street 1:CALLE FLOR GERENA 13
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-518-0104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84851DEOtherTRIPLE S
PRP070OtherFIRST MEDICAL
PR212353OtherPREFERRED HEALTH
PR4069OtherUHC
PR=========OtherPREFERRED MEDICARE CHOICE
PR4069OtherUHC
PR=========OtherBLUE CROSS, MCS, TRICARE