Provider Demographics
NPI:1619236171
Name:NEFROLOGY & MEDICAL SERVICES PSC
Entity Type:Organization
Organization Name:NEFROLOGY & MEDICAL SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORA-RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-740-1011
Mailing Address - Street 1:PO BOX 9220
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-9220
Mailing Address - Country:US
Mailing Address - Phone:787-740-1011
Mailing Address - Fax:787-740-1008
Practice Address - Street 1:66 CALLE SANTA CRUZ
Practice Address - Street 2:SUITE 503 INSTITUTO SAN PABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-740-1011
Practice Address - Fax:787-740-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8838261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty