Provider Demographics
NPI:1992943096
Name:LP RENAL SERVICES, CSP
Entity type:Organization
Organization Name:LP RENAL SERVICES, CSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARIA
Authorized Official - Prefix:
Authorized Official - First Name:YOMALIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GINES-SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-854-4170
Mailing Address - Street 1:STREET HERNANDEZ CARRION ATENAS AVE.
Mailing Address - Street 2:HOSP. MANATI MEDICAL CENTER SUITE 104B
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0407
Mailing Address - Country:US
Mailing Address - Phone:787-854-4170
Mailing Address - Fax:787-854-4493
Practice Address - Street 1:668 HERNANDEZ CARRION STREET ATENAS AVE
Practice Address - Street 2:MANATI MEDICAL CENTER HOSP. SUITE 104B
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0000
Practice Address - Country:US
Practice Address - Phone:787-854-4170
Practice Address - Fax:787-854-4493
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LP RENAL SERVICES, CSP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty