Provider Demographics
NPI:1760626634
Name:PHYMED
Entity Type:Organization
Organization Name:PHYMED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTER MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:EILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DE-JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-774-0707
Mailing Address - Street 1:CARR 165 # KM
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-8047
Mailing Address - Country:US
Mailing Address - Phone:787-774-0707
Mailing Address - Fax:787-775-0202
Practice Address - Street 1:CARR 165 # KM 1.2 # 48 CITY VIEW PLAZA
Practice Address - Street 2:SUITE 115
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-8047
Practice Address - Country:US
Practice Address - Phone:787-774-0707
Practice Address - Fax:787-775-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13991174400000X
PR15909174400000X
PR13925174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty