# INTERMED EAST LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154741395
- **Authorized official:** MISS IDIA L VELAZQUEZ (M.D.)
- **Authorized official phone:** (787) 342-8201

## Contact information

- **Practice address:** FONT MARTELO 123 STREET, HUMACAO, PR 00791
- **Practice address phone:** (787) 852-3417
- **Practice address fax:** (787) 859-7861
- **Mailing address:** PO BOX 1197, LAS PIEDRAS, PR 00771-1197
- **Mailing address phone:** (787) 342-8201
- **Mailing address fax:** (787) 850-7861

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 13901 | PR | Yes |

## Other

- **Enumeration date:** 04/25/2014
- **Last updated:** 04/25/2014