Provider Demographics
NPI:1558117648
Name:SERVICOS MEDICOS EQR CSP
Entity type:Organization
Organization Name:SERVICOS MEDICOS EQR CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVARISTO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINONES RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-868-4378
Mailing Address - Street 1:HC 58 BOX 14748
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-868-4378
Mailing Address - Fax:787-868-4378
Practice Address - Street 1:CARR 417 KM 02 BO PIEDRICS BLANCAS
Practice Address - Street 2:DESVIO SUR
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-4378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty