Provider Demographics
NPI:1609290303
Name:SERVICIOS MEDICOS DEL NORESTE
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS DEL NORESTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-863-4058
Mailing Address - Street 1:410 AVE GENERAL VALERO
Mailing Address - Street 2:SUITE 307
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3949
Mailing Address - Country:US
Mailing Address - Phone:787-863-4058
Mailing Address - Fax:787-801-7344
Practice Address - Street 1:410 AVE GENERAL VALERO
Practice Address - Street 2:SUITE 307
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3949
Practice Address - Country:US
Practice Address - Phone:787-863-4058
Practice Address - Fax:787-801-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-15
Last Update Date:2014-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12274302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR332606OtherPROFESSIONAL CORPORATION REGISTRATION NUMBER