Provider Demographics
NPI:1730128265
Name:EM PHYSICIANS OF PUERTO RICO PSC
Entity Type:Organization
Organization Name:EM PHYSICIANS OF PUERTO RICO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFEDO
Authorized Official - Middle Name:L
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-771-7930
Mailing Address - Street 1:PO BOX 29582
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0582
Mailing Address - Country:US
Mailing Address - Phone:787-771-7930
Mailing Address - Fax:787-771-7390
Practice Address - Street 1:AVE PONCE DE LEON # 715
Practice Address - Street 2:PDA 37
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-771-7930
Practice Address - Fax:787-771-7390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty