Provider Demographics
NPI:1295269900
Name:ENDOMED LLC
Entity type:Organization
Organization Name:ENDOMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALITZA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALVAREZ VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-315-5170
Mailing Address - Street 1:PO BOX 192485
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-2485
Mailing Address - Country:US
Mailing Address - Phone:787-315-5170
Mailing Address - Fax:
Practice Address - Street 1:655 CALLE EUROPA, EDIF CHINEA
Practice Address - Street 2:OFICINA 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-0090
Practice Address - Country:US
Practice Address - Phone:787-727-8295
Practice Address - Fax:787-727-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18108261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty