Provider Demographics
NPI:1639643018
Name:ENDOPR IELO LLC
Entity Type:Organization
Organization Name:ENDOPR IELO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LABOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-746-7066
Mailing Address - Street 1:PO BOX 9341
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-9341
Mailing Address - Country:US
Mailing Address - Phone:787-510-0398
Mailing Address - Fax:939-337-5287
Practice Address - Street 1:BS4 AVENIDA LAS AMERICAS BAIROA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-746-7066
Practice Address - Fax:939-337-5287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR18331OtherMED LIC