Provider Demographics
NPI:1972931319
Name:PROMISE MEDICAL P.S.C.
Entity type:Organization
Organization Name:PROMISE MEDICAL P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-251-7614
Mailing Address - Street 1:PO BOX 8929
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8929
Mailing Address - Country:US
Mailing Address - Phone:787-251-7614
Mailing Address - Fax:787-251-7608
Practice Address - Street 1:MAIN AVE 12-54
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-9998
Practice Address - Country:US
Practice Address - Phone:787-251-7614
Practice Address - Fax:787-251-7608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR014466261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care