Provider Demographics
NPI:1952741886
Name:IMPERIAL MEDICAL SERVICES, C. S. P.
Entity type:Organization
Organization Name:IMPERIAL MEDICAL SERVICES, C. S. P.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-791-8175
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0486
Mailing Address - Country:US
Mailing Address - Phone:787-791-8175
Mailing Address - Fax:787-791-8179
Practice Address - Street 1:ISLA VERDE MALL SUITE 208
Practice Address - Street 2:6777 AVE. ISLA VERDE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00979-0000
Practice Address - Country:US
Practice Address - Phone:787-791-8175
Practice Address - Fax:787-791-8179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR009228208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty