Provider Demographics
NPI:1619131406
Name:INTERNAL MEDICINE PERIOPERATIVE CONSULTANTS PSC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE PERIOPERATIVE CONSULTANTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-453-0583
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:PMB 157
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715
Mailing Address - Country:US
Mailing Address - Phone:787-841-5549
Mailing Address - Fax:787-840-3030
Practice Address - Street 1:909 TITO CASTRO AVE
Practice Address - Street 2:TORRE MEDICA SAN LUCAS SUITE 717
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-453-0583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14914261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5200OtherPUERTO RICO DEPARTMENT OF STATE