Provider Demographics
NPI:1790984474
Name:INSTITUTO MEDICO DEL DOLOR Y MEDICINA COMPLEMENTARIA
Entity Type:Organization
Organization Name:INSTITUTO MEDICO DEL DOLOR Y MEDICINA COMPLEMENTARIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:TORRES CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-296-3223
Mailing Address - Street 1:652 MUNOZ RIVERA AVE.
Mailing Address - Street 2:MONTE MALL BLDG SUITE 2070
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4149
Mailing Address - Country:US
Mailing Address - Phone:787-293-3223
Mailing Address - Fax:787-759-3000
Practice Address - Street 1:652 MUNOZ RIVERA AVE.
Practice Address - Street 2:MONTE MALL BLDG SUITE 2070
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4149
Practice Address - Country:US
Practice Address - Phone:787-293-3223
Practice Address - Fax:787-759-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR165, 10076261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty