Provider Demographics
NPI:1992855746
Name:EL MEDICO VISITANTE...,P.S.C.
Entity Type:Organization
Organization Name:EL MEDICO VISITANTE...,P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-385-4924
Mailing Address - Street 1:PO BOX 364422
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4422
Mailing Address - Country:US
Mailing Address - Phone:787-385-4924
Mailing Address - Fax:787-771-5151
Practice Address - Street 1:951 AVE AMERICO MIRANDA
Practice Address - Street 2:REPARTO METROPOLITANO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2801
Practice Address - Country:US
Practice Address - Phone:787-385-4924
Practice Address - Fax:787-771-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0085121Medicare PIN