| Centro Medico Iberoamericano Inc. | |
|
416 Park Ave Paterson NJ 07504-1930 | |
| (973) 684-8138 | |
| (973) 684-0032 |
| Full Name | Centro Medico Iberoamericano Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 416 Park Ave, Paterson, New Jersey |
| Authorized Official Name and Position | Ramon Antonio Sandoval (OWNER) |
| Authorized Official Contact | 9736848138 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centro Medico Iberoamericano Inc. 416 Park Ave Paterson NJ 07504-1930 Ph: (973) 684-8138 | Centro Medico Iberoamericano Inc. 416 Park Ave Paterson NJ 07504-1930 Ph: (973) 684-8138 |
| NPI Number | 1255520482 |
|---|---|
| Provider Enumeration Date | 10/24/2007 |
| Last Update Date | 12/19/2011 |
| Medicare PECOS PAC ID | 9830287176 |
|---|---|
| Medicare Enrollment ID | O20071120000234 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255520482 | NPI | - | NPPES |
| 1055488 | Other | HORIZON NJ HEALTH | |
| 6051308 | Medicaid | NJ | |
| F73229 | Other | UPIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (New Jersey) | Primary |
| Provider Name | Ramon A Sandoval |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316032014 PECOS PAC ID: 0648215541 Enrollment ID: I20050622000056 |
| Provider Name | Juan A Desueza |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871683821 PECOS PAC ID: 4688722754 Enrollment ID: I20090429000105 |
| Provider Name | Melissa Amy Desueza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235634189 PECOS PAC ID: 1850640756 Enrollment ID: I20180827002326 |
| Provider Name | Nidia M Ortega |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013392935 PECOS PAC ID: 1557677549 Enrollment ID: I20210224000895 |
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