Provider Demographics
NPI:1891979027
Name:SERVICIOS MEDICOS PROFESIONALES 1,2,3
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS PROFESIONALES 1,2,3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:DARIO
Authorized Official - Last Name:ROSARIO CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-464-5065
Mailing Address - Street 1:CARR. 116 K.M 2.0 CANITAS II BO. YEGUA
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-899-2865
Mailing Address - Fax:787-808-0668
Practice Address - Street 1:CARR. 116 K.M 2.0 CANITAS II BO. YEGUA
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-2865
Practice Address - Fax:787-808-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR175239OtherREGISTER CERTIFICATE