Provider Demographics
NPI:1699253765
Name:RED DE MEDICOS ASOCIADOS DEL SUR, INC
Entity type:Organization
Organization Name:RED DE MEDICOS ASOCIADOS DEL SUR, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:YAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-892-8092
Mailing Address - Street 1:PO BOX 80
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0080
Mailing Address - Country:US
Mailing Address - Phone:787-892-8092
Mailing Address - Fax:888-777-9122
Practice Address - Street 1:PR10 KM 0.1 BARRIO CANAS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-892-8092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RED DE MEDICOS ASOCIADOS DEL SUR, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center