Provider Demographics
NPI:1578653937
Name:RED DE MEDICOS ASOCIADOS DEL SUR, INC
Entity Type:Organization
Organization Name:RED DE MEDICOS ASOCIADOS DEL SUR, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-267-5829
Mailing Address - Street 1:PO BOX 3060
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3060
Mailing Address - Country:US
Mailing Address - Phone:787-267-5829
Mailing Address - Fax:787-267-0071
Practice Address - Street 1:CALLE 65 DE INFANTERIA #1
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3060
Practice Address - Country:US
Practice Address - Phone:787-267-5829
Practice Address - Fax:787-267-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service