Provider Demographics
NPI:1962783837
Name:BERDIEL & ASOCIADOS CSP
Entity type:Organization
Organization Name:BERDIEL & ASOCIADOS CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERDIEL-APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-210-3745
Mailing Address - Street 1:462 CALLE GAVIOTA
Mailing Address - Street 2:CAMINOS DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2840
Mailing Address - Country:US
Mailing Address - Phone:787-210-3745
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:1227 AVE MUNOZ RIVERA
Practice Address - Street 2:VILLA GRILLASCA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0634
Practice Address - Country:US
Practice Address - Phone:787-210-3745
Practice Address - Fax:787-848-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16750208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty