Provider Demographics
NPI:1982885836
Name:SERVICIOS MEDICOS BETHESDA CSP
Entity Type:Organization
Organization Name:SERVICIOS MEDICOS BETHESDA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:GONZALEZ-INGLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-288-2255
Mailing Address - Street 1:J16 CALLE 2 STE 108
Mailing Address - Street 2:CALLE J ESQUINA CALLE B EXTENSION VILLA RICA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5045
Mailing Address - Country:US
Mailing Address - Phone:787-288-2255
Mailing Address - Fax:787-288-2255
Practice Address - Street 1:J16 CALLE 2 STE 108
Practice Address - Street 2:CALLE J ESQUINA CALLE B EXTENSION VILLA RICA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5045
Practice Address - Country:US
Practice Address - Phone:787-288-2255
Practice Address - Fax:787-288-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty