Provider Demographics
NPI:1821326331
Name:DISPENSARIO MEDICO LA MONSERRATE
Entity Type:Organization
Organization Name:DISPENSARIO MEDICO LA MONSERRATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANDESTOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-762-9424
Mailing Address - Street 1:AL5 VIA ELENA
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-3901
Mailing Address - Country:US
Mailing Address - Phone:787-762-9424
Mailing Address - Fax:
Practice Address - Street 1:AL5 VIA ELENA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-3901
Practice Address - Country:US
Practice Address - Phone:787-762-9424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7570261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE57434Medicare UPIN