Provider Demographics
NPI:1811395395
Name:ISLOTE MEDICAL SOLUTIONS CORPORATION
Entity type:Organization
Organization Name:ISLOTE MEDICAL SOLUTIONS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:TAC-III-05-20-2051
Authorized Official - Phone:787-636-5443
Mailing Address - Street 1:CARR 681 # KM4.4
Mailing Address - Street 2:BO. ISLOTE
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-5313
Mailing Address - Country:US
Mailing Address - Phone:787-881-5073
Mailing Address - Fax:787-878-0948
Practice Address - Street 1:CARRETERA 681 KM 4.4
Practice Address - Street 2:BARRIO ISLOTE
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-0948
Practice Address - Fax:787-881-5073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRCB-0712261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder