Provider Demographics
NPI:1770711624
Name:SOCIEDAD QUIRURGICA CSP
Entity type:Organization
Organization Name:SOCIEDAD QUIRURGICA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ITURREGUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-294-0940
Mailing Address - Street 1:AVE PONCE DE LEON # 735
Mailing Address - Street 2:TORRE AUXILIO MUTUO SUITE 603
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1000
Mailing Address - Country:US
Mailing Address - Phone:787-294-0940
Mailing Address - Fax:787-294-0943
Practice Address - Street 1:AVE PONCE DE LEON # 735
Practice Address - Street 2:TORRE AUXILIO MUTUO SUITE 603
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1000
Practice Address - Country:US
Practice Address - Phone:787-294-0940
Practice Address - Fax:787-294-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC84066Medicare UPIN