Provider Demographics
NPI:1932317740
Name:GIPECD MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:GIPECD MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUXO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-200-0324
Mailing Address - Street 1:PO BOX 51519
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1519
Mailing Address - Country:US
Mailing Address - Phone:787-200-0324
Mailing Address - Fax:787-200-0325
Practice Address - Street 1:BOULEVARD MONROIG Y38
Practice Address - Street 2:4FA SECC. LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-200-0324
Practice Address - Fax:787-200-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021188Medicare ID - Type UnspecifiedDR. JOSE R OLLER
PRI35588Medicare UPIN
PRI51650Medicare UPIN