Provider Demographics
NPI:1629279781
Name:INSTITUTO DE MEDICINA INTERNA Y GERIATRIA
Entity Type:Organization
Organization Name:INSTITUTO DE MEDICINA INTERNA Y GERIATRIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ-SIFRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-751-8739
Mailing Address - Street 1:F.D. ROOSEVELT AVE.
Mailing Address - Street 2:SUITE 408
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1156
Mailing Address - Country:US
Mailing Address - Phone:787-751-8739
Mailing Address - Fax:
Practice Address - Street 1:400 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 408
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1156
Practice Address - Country:US
Practice Address - Phone:787-751-8739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6881174400000X
PR7387174400000X
PR9138174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRW-55372Medicare UPIN
PR0082006Medicare PIN
PRE-11487Medicare UPIN
PRE-66485Medicare UPIN
PRC-78274Medicare UPIN