| Riaza Integrated Medical Services Llc | |
|
502 Calle Riaza San Juan PR 00923-2120 | |
| (787) 635-2840 | |
| Not Available |
| Full Name | Riaza Integrated Medical Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 502 Calle Riaza, San Juan, Puerto Rico |
| Authorized Official Name and Position | Wanda E Gomez (PRESIDENT) |
| Authorized Official Contact | 7876352840 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riaza Integrated Medical Services Llc Po Box 21406 San Juan PR 00928-1406 Ph: (787) 635-2840 | Riaza Integrated Medical Services Llc 502 Calle Riaza San Juan PR 00923-2120 Ph: (787) 635-2840 |
| NPI Number | 1689340853 |
|---|---|
| Provider Enumeration Date | 08/18/2021 |
| Last Update Date | 03/17/2022 |
| Certification Date | 03/17/2022 |
| Medicare PECOS PAC ID | 8022488105 |
|---|---|
| Medicare Enrollment ID | O20230105003095 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689340853 | NPI | - | NPPES |
| Provider Name | Jorge Luis Rullan Gonzalez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871026237 PECOS PAC ID: 5890178297 Enrollment ID: I20220817003979 |
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