Provider Demographics
NPI:1821220948
Name:DRA LOURDES KUTBI PSC
Entity Type:Organization
Organization Name:DRA LOURDES KUTBI PSC
Other - Org Name:DRA LOURDES KUTBI PSC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-778-6676
Mailing Address - Street 1:73 CALLE SANTA CRUZ STE 412
Mailing Address - Street 2:URB SANTA CRUZ
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6942
Mailing Address - Country:US
Mailing Address - Phone:787-778-6676
Mailing Address - Fax:787-778-6676
Practice Address - Street 1:73 CALLE SANTA CRUZ STE 412
Practice Address - Street 2:URB SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6942
Practice Address - Country:US
Practice Address - Phone:787-778-6676
Practice Address - Fax:787-778-6676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRDPM098213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty