Provider Demographics
NPI:1205084407
Name:EMBD MEDICS PSC
Entity type:Organization
Organization Name:EMBD MEDICS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:X
Authorized Official - Last Name:MARRERO-DE GRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-599-1174
Mailing Address - Street 1:R11 CALLE 2
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-4315
Mailing Address - Country:US
Mailing Address - Phone:787-599-1174
Mailing Address - Fax:
Practice Address - Street 1:INST SAN PABLO
Practice Address - Street 2:SUITE 503
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-740-1011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty