Provider Demographics
NPI:1649406976
Name:RJBV INTERNAL MEDICINE, PSC
Entity Type:Organization
Organization Name:RJBV INTERNAL MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:BLONDET VISSEPO
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:787-842-5315
Mailing Address - Street 1:8131 CALLE CONCORDIA STE 101
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1547
Mailing Address - Country:US
Mailing Address - Phone:787-842-5315
Mailing Address - Fax:787-813-2626
Practice Address - Street 1:8131 CALLE CONCORDIA STE 101
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1547
Practice Address - Country:US
Practice Address - Phone:787-842-5315
Practice Address - Fax:787-813-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCW998AMedicaid
PR0023423Medicare PIN