Provider Demographics
NPI:1689629115
Name:INTERNAL MEDICINE CANOVANAS GROUP CORP.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CANOVANAS GROUP CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:R
Authorized Official - Last Name:MARTE CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-256-0848
Mailing Address - Street 1:PMB 121 PO BOX 20000
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729
Mailing Address - Country:US
Mailing Address - Phone:787-256-0848
Mailing Address - Fax:787-256-2990
Practice Address - Street 1:CALLE ORQUIDEA A-48 URB LOIZA VALLEY
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-0848
Practice Address - Fax:787-256-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80289Medicare ID - Type UnspecifiedMEDICAL GROUP