Provider Demographics
NPI:1013907864
Name:INSTITUTO NEUMOLOGICO DE PUERTO RICO
Entity Type:Organization
Organization Name:INSTITUTO NEUMOLOGICO DE PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIO-GESTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ SERVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FCCP
Authorized Official - Phone:787-765-1919
Mailing Address - Street 1:EDIF CLINICA LAS AMERICAS OFIC 205
Mailing Address - Street 2:400 ROOSEVELT AVE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-765-1919
Mailing Address - Fax:787-763-4049
Practice Address - Street 1:EDIF CLINICA LAS AMERICAS OFIC 205
Practice Address - Street 2:400 ROOSEVELT AVE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-765-1919
Practice Address - Fax:787-763-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80118Medicare ID - Type UnspecifiedNUMERO PROVEEDOR