Provider Demographics
NPI:1134539810
Name:AM INTERMEDICAL LLC
Entity type:Organization
Organization Name:AM INTERMEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVA
Authorized Official - Middle Name:NYDIA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-969-9051
Mailing Address - Street 1:PO BOX 29430
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0430
Mailing Address - Country:US
Mailing Address - Phone:787-768-4278
Mailing Address - Fax:787-769-2220
Practice Address - Street 1:820 CALLE MOLUCAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-1723
Practice Address - Country:US
Practice Address - Phone:787-768-4278
Practice Address - Fax:787-769-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty