Provider Demographics
NPI:1801879135
Name:INTERNAL MEDICINE AND PREVENTIVE CARE SERVICE CSP
Entity type:Organization
Organization Name:INTERNAL MEDICINE AND PREVENTIVE CARE SERVICE CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIZMENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-269-3015
Mailing Address - Street 1:BAYAMON MEDICAL PLZ
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7200
Mailing Address - Country:US
Mailing Address - Phone:787-269-3015
Mailing Address - Fax:787-740-4720
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:SUITE 505
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-269-3015
Practice Address - Fax:787-740-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
84901OtherT-S
E43415Medicare UPIN
84901OtherT-S