Provider Demographics
NPI:1851758361
Name:RV MEDICAL PSC
Entity Type:Organization
Organization Name:RV MEDICAL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-850-6654
Mailing Address - Street 1:HC 4 BOX 19741
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-8840
Mailing Address - Country:US
Mailing Address - Phone:787-850-6654
Mailing Address - Fax:787-719-4677
Practice Address - Street 1:CARR 3 KM 85.5
Practice Address - Street 2:BO CANDELERO ARRIBA OFICINA 2 EDIFICIO PLAZA DEL MAR
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00792
Practice Address - Country:US
Practice Address - Phone:787-850-6654
Practice Address - Fax:787-719-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6182261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service