Provider Demographics
NPI:1104799337
Name:ID CARE PR LLC
Entity type:Organization
Organization Name:ID CARE PR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHYANN
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:GARCIA MATEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-370-3252
Mailing Address - Street 1:2049 CALLE LUIS XIV
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2049 CALLE LUIS XIV
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-7846
Practice Address - Country:US
Practice Address - Phone:787-370-3252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty