Provider Demographics
NPI:1881889947
Name:OCEANSIDE MEDICAL SERVICES CORP
Entity type:Organization
Organization Name:OCEANSIDE MEDICAL SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:DR
Authorized Official - First Name:IBELITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-830-5914
Mailing Address - Street 1:3107 CALLE BERMUDA
Mailing Address - Street 2:UBR ISLAZUL
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-6354
Mailing Address - Country:US
Mailing Address - Phone:787-830-5914
Mailing Address - Fax:787-877-2145
Practice Address - Street 1:EDIFICIO PLAZA DEL MAR CARR 459 KM 11.4
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-5914
Practice Address - Fax:787-877-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16169261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center