Provider Demographics
NPI:1699946236
Name:INSTITUTO VASCULAR DEL SUR CSP
Entity type:Organization
Organization Name:INSTITUTO VASCULAR DEL SUR CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TORRUELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-284-0804
Mailing Address - Street 1:909 AVE. TITO CASTRO SUITE 822
Mailing Address - Street 2:TORRE MEDICA SAN LUCAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4725
Mailing Address - Country:US
Mailing Address - Phone:787-284-0804
Mailing Address - Fax:787-284-0512
Practice Address - Street 1:909 AVE. TITO CASTRO SUITE 822
Practice Address - Street 2:TORRE MEDICA SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4725
Practice Address - Country:US
Practice Address - Phone:787-284-0804
Practice Address - Fax:787-284-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR105362086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty