Provider Demographics
NPI:1821542234
Name:PRIME OTOLARYNGOLOGY SERVICES, PSC
Entity Type:Organization
Organization Name:PRIME OTOLARYNGOLOGY SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-706-4334
Mailing Address - Street 1:PO BOX 1036
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1036
Mailing Address - Country:US
Mailing Address - Phone:787-706-4334
Mailing Address - Fax:787-749-0993
Practice Address - Street 1:1510 AVE F.D. ROOSEVELT
Practice Address - Street 2:MEZZANINE SUITE B
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-2602
Practice Address - Country:US
Practice Address - Phone:787-706-4334
Practice Address - Fax:787-749-0993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11652207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty