Provider Demographics
NPI:1356595128
Name:J.W. GOVEO P.S.C. MEDICAL SERVICES
Entity type:Organization
Organization Name:J.W. GOVEO P.S.C. MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCUMBANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUNSBERRY GOVEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:787-439-4892
Mailing Address - Street 1:425 CARR. 693 PMB 103
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-439-4892
Mailing Address - Fax:787-626-7842
Practice Address - Street 1:EDIFCIO LAS VEGAS # 420
Practice Address - Street 2:BARRIO COTTO NORTE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-310-9731
Practice Address - Fax:787-626-7842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13010208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty