Provider Demographics
NPI:1861409898
Name:FFV ID MED GROUP PSC
Entity type:Organization
Organization Name:FFV ID MED GROUP PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-748-3818
Mailing Address - Street 1:300 BOULEVARD RAMALLO
Mailing Address - Street 2:CARR 1 OFF 213
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6372
Mailing Address - Country:US
Mailing Address - Phone:787-748-3818
Mailing Address - Fax:
Practice Address - Street 1:300 BOULEVARD RAMALLO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-6372
Practice Address - Country:US
Practice Address - Phone:787-748-3818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084660Medicare ID - Type Unspecified