Provider Demographics
NPI:1417739087
Name:ISLAND SURGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:ISLAND SURGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:MS
Authorized Official - First Name:MINERVA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-646-4331
Mailing Address - Street 1:PO BOX 3627
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3627
Mailing Address - Country:US
Mailing Address - Phone:787-705-4545
Mailing Address - Fax:
Practice Address - Street 1:MAYAGUEZ MEDICAL CENTER
Practice Address - Street 2:401 HOSTOS AVE STREET 2 OFFICE 125
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-646-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty