Provider Demographics
NPI:1154741395
Name:INTERMED EAST LLC
Entity type:Organization
Organization Name:INTERMED EAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MISS
Authorized Official - First Name:IDIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-342-8201
Mailing Address - Street 1:PO BOX 1197
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1197
Mailing Address - Country:US
Mailing Address - Phone:787-342-8201
Mailing Address - Fax:787-850-7861
Practice Address - Street 1:FONT MARTELO 123 STREET
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-3417
Practice Address - Fax:787-859-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty