Provider Demographics
NPI:1962507509
Name:INSTITUTO DE PODIATRIA Y PIE DIABETICO DE PUERTO RICO
Entity Type:Organization
Organization Name:INSTITUTO DE PODIATRIA Y PIE DIABETICO DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:ARROYO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:787-782-1453
Mailing Address - Street 1:1494 AVE FD ROOSEVELT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-2700
Mailing Address - Country:US
Mailing Address - Phone:787-782-1453
Mailing Address - Fax:787-273-1452
Practice Address - Street 1:1494 AVE FD ROOSEVELT
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-2700
Practice Address - Country:US
Practice Address - Phone:787-782-1453
Practice Address - Fax:787-273-1452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0094261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU09100Medicare UPIN
PROO84095Medicare ID - Type Unspecified