Provider Demographics
NPI:1942638440
Name:INSTITUTO DE MEDICINA INTEGRATIVA Y PSICOESPIRITUAL
Entity Type:Organization
Organization Name:INSTITUTO DE MEDICINA INTEGRATIVA Y PSICOESPIRITUAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:G
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-854-0026
Mailing Address - Street 1:B87 CALLE TIRADO GARCIA
Mailing Address - Street 2:URB. ATENAS
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4631
Mailing Address - Country:US
Mailing Address - Phone:787-220-0883
Mailing Address - Fax:787-854-0026
Practice Address - Street 1:B87 CALLE TIRADO GARCIA
Practice Address - Street 2:URB. ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4631
Practice Address - Country:US
Practice Address - Phone:787-220-0883
Practice Address - Fax:787-854-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11866174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty