Provider Demographics
NPI:1003220153
Name:I & C PSC
Entity type:Organization
Organization Name:I & C PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CEREZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-390-7771
Mailing Address - Street 1:772 CALLE MAR NEGRO
Mailing Address - Street 2:PASEOS LOS CORALES II
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4546
Mailing Address - Country:US
Mailing Address - Phone:787-390-7771
Mailing Address - Fax:
Practice Address - Street 1:772 CALLE MAR NEGRO
Practice Address - Street 2:PASEOS LOS CORALES II
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4546
Practice Address - Country:US
Practice Address - Phone:787-390-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16645207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty