Provider Demographics
NPI:1932383163
Name:OFICINA HORARIO EXTENDIDO IPA 29
Entity Type:Organization
Organization Name:OFICINA HORARIO EXTENDIDO IPA 29
Other - Org Name:OFICINA HORARIO EXTENDIDO IPA 29
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIBAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-895-0914
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0903
Mailing Address - Country:US
Mailing Address - Phone:787-895-0914
Mailing Address - Fax:787-895-0914
Practice Address - Street 1:CALLE MARGINAL DEL PARQUE
Practice Address - Street 2:BO TERRANOVA CARR 2
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-0917
Practice Address - Fax:787-895-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11789209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes209800000XAllopathic & Osteopathic PhysiciansLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR17119OtherTRIPLES INC