Provider Demographics
NPI:1295282499
Name:FUNCTIONAL ENDOCRINOLOGY INSTITUTE P.S.C
Entity type:Organization
Organization Name:FUNCTIONAL ENDOCRINOLOGY INSTITUTE P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANSILLA LETELIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-233-9108
Mailing Address - Street 1:PO BOX 2447
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-2447
Mailing Address - Country:US
Mailing Address - Phone:787-400-0333
Mailing Address - Fax:
Practice Address - Street 1:120 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-400-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18179302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization