Provider Demographics
NPI:1013325372
Name:DR FARES CID MANSUR, PSC
Entity type:Organization
Organization Name:DR FARES CID MANSUR, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARES
Authorized Official - Middle Name:A
Authorized Official - Last Name:CID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-812-1210
Mailing Address - Street 1:PMB 383 609
Mailing Address - Street 2:AVE TITO CASTRO STE 102
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-812-1210
Mailing Address - Fax:787-812-1211
Practice Address - Street 1:EDIF MICHELLE PLAZA
Practice Address - Street 2:STE106 CALLE ACASIA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-812-1210
Practice Address - Fax:787-812-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10164207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty