Provider Demographics
NPI:1982048955
Name:PEPINO INTERNAL MEDICINE GROUP INC
Entity type:Organization
Organization Name:PEPINO INTERNAL MEDICINE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YAZMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SOTO GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-926-0507
Mailing Address - Street 1:PO BOX 3277
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7005
Mailing Address - Country:US
Mailing Address - Phone:787-926-0507
Mailing Address - Fax:787-926-0507
Practice Address - Street 1:3 JOSE MENDEZ CARDONA
Practice Address - Street 2:CENTRO MEDICINA Y CIRUGIA AMBULATORIA SUITE 202
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-9998
Practice Address - Country:US
Practice Address - Phone:787-340-8175
Practice Address - Fax:787-926-0507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16234207R00000X, 208M00000X
PR20042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRFG602AMedicare UPIN