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NPI Code Detail

MEDICARE: PHYSICIAN HMO INC.

MEDICARE: PHYSICIAN HMO INC.
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
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1689946956
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIAN HMO INC.
Provider Business Mailing Address
First Line : PO BOX 193044
Second Line :
City : SAN JUAN
State : PR
Zip : 00919-3044
Country : US
Telephone Number : 787-767-8758
Fax Number :
Provider Business Practice Location Address
First Line : 107 CALLE PADRE LAS CASAS
Second Line :
City : SAN JUAN
State : PR
Zip : 00918-3104
Country : US
Telephone Number : 787-767-8758
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. RAUL D VILLALOBOS
Credential : MD
Telephone Number : 787-767-8758
Provider Enumeration Date : 02/02/2012
Last Update Date : 10/24/2012

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Directions to “PHYSICIAN HMO INC. ” Practice Location

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