Provider Demographics
NPI:1306570551
Name:INTERCAMBIOS PUERTO RICO, INC
Entity type:Organization
Organization Name:INTERCAMBIOS PUERTO RICO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:TORRUELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-678-9008
Mailing Address - Street 1:165 CALLE DIEGO ZALDUONDO
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4729
Mailing Address - Country:US
Mailing Address - Phone:787-678-9008
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE ANTONIO R BARCELO W
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-5195
Practice Address - Country:US
Practice Address - Phone:787-908-8162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health