Provider Demographics
NPI:1841400637
Name:INTEGRATIVE DIABETIC RESEARCH CENTER
Entity type:Organization
Organization Name:INTEGRATIVE DIABETIC RESEARCH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-607-9857
Mailing Address - Street 1:D12 CALLE ROMA
Mailing Address - Street 2:VILLA CAPARRA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-1725
Mailing Address - Country:US
Mailing Address - Phone:787-608-9857
Mailing Address - Fax:
Practice Address - Street 1:D12 CALLE ROMA
Practice Address - Street 2:VILLA CAPARRA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-1725
Practice Address - Country:US
Practice Address - Phone:787-608-9857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084970Medicare ID - Type Unspecified