Provider Demographics
NPI:1568916203
Name:INSTITUTO MEDICO FAMILIAR DEL ESTE
Entity Type:Organization
Organization Name:INSTITUTO MEDICO FAMILIAR DEL ESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-256-2015
Mailing Address - Street 1:58 CALLE CORCHADO
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3102
Mailing Address - Country:US
Mailing Address - Phone:787-256-2015
Mailing Address - Fax:787-256-5043
Practice Address - Street 1:58 CALLE CORCHADO
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3102
Practice Address - Country:US
Practice Address - Phone:787-256-2015
Practice Address - Fax:787-256-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085002OtherMEDICARE