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NPI Code Detail

MEDICARE: GCM MEDICAL GROUP, PSC

MEDICARE: GCM MEDICAL GROUP, PSC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QR1100XResearch Clinic/Center16033PR
2261QP2300XPrimary Care Clinic/Center16033PR

General Provider Information

NPI Number : 1023307915
Entity Type Code : Organization
Provider Name (Legal Business Name) : GCM MEDICAL GROUP, PSC
Provider Business Mailing Address
First Line : PO BOX 13867
Second Line :
City : SAN JUAN
State : PR
Zip : 00908-3867
Country : US
Telephone Number : 787-726-8396
Fax Number : 787-919-0640
Provider Business Practice Location Address
First Line : 1826 AVE FERNANDEZ JUNCOS
Second Line :
City : SAN JUAN
State : PR
Zip : 00909-3004
Country : US
Telephone Number : 787-726-8396
Fax Number : 787-919-0640
Authorized Official
Title or Position : PRESIDENT
Name : DR. GREGORIO ANTONIO CORTES MAISONET
Credential : M.D.
Telephone Number : 787-726-8396
Provider Enumeration Date : 03/31/2011
Last Update Date : 03/31/2011

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