Provider Demographics
NPI:1891232633
Name:IPPA SALUD COOP
Entity Type:Organization
Organization Name:IPPA SALUD COOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-740-0713
Mailing Address - Street 1:PO BOX 70169
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00936
Mailing Address - Country:UM
Mailing Address - Phone:787-751-5979
Mailing Address - Fax:787-281-7669
Practice Address - Street 1:20 OFFICE PARK RD
Practice Address - Street 2:EDIFICIO ASSERTUS SUITE 302
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-751-5979
Practice Address - Fax:787-281-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center