Provider Demographics
NPI:1679811178
Name:IQ CORPORATION, P.S.C.
Entity Type:Organization
Organization Name:IQ CORPORATION, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD GENERAL PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ SAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-241-6256
Mailing Address - Street 1:URB LA RIVIERA
Mailing Address - Street 2:CONDOMINIO MEDICAL CENTER PLAZE APT 307
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00921-0000
Mailing Address - Country:US
Mailing Address - Phone:787-241-6256
Mailing Address - Fax:
Practice Address - Street 1:15 CALLE DR BASORA N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4833
Practice Address - Country:US
Practice Address - Phone:787-241-6256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90248OtherPTAN MEDICARE