Basic Information
| Provider Information | |||||||||
| NPI: | 1619008976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERMED EMERGENCY SERVICES PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 GRAN BULEVAR PASEOS | ||||||||
| Address2: | SUITE 112-297 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872920600 | ||||||||
| FaxNumber: | 7877612094 | ||||||||
| Practice Location | |||||||||
| Address1: | URB. MARIOLGA | ||||||||
| Address2: | AVE. LUIS MUNOZ MARIN, ESQ. DEGETAU | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876533434 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SEPULVEDA | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7872920600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.