Provider Demographics
NPI:1912395914
Name:IGR MEDICAL SERVICES PSC
Entity Type:Organization
Organization Name:IGR MEDICAL SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:DR
Authorized Official - First Name:IOLANI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA ROSARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-435-1826
Mailing Address - Street 1:HC 66 BOX 8316
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-9708
Mailing Address - Country:US
Mailing Address - Phone:787-435-1826
Mailing Address - Fax:
Practice Address - Street 1:375 AVE GENERAL VALERO
Practice Address - Street 2:SUITE 105
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4893
Practice Address - Country:US
Practice Address - Phone:787-435-1826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18330207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR340347OtherCERTIFICADO DE REGISTRO