MEDICARE: COMPCARE DE PUERTO RICO

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
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1801193065
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPCARE DE PUERTO RICO

Provider Business Mailing Address
First Line	:	METRO OFFICE PARK
Second Line	:	PARKSIDE PLAZA 14 CALLE 12 SUITE 405
City	:	GUAYNABO
State	:	PR
Zip	:	00968-1704
Country	:	US
Telephone Number	:	787-522-4400
Fax Number	:	787-522-4401

Provider Business Practice Location Address
First Line	:	METRO OFFICE PARK
Second Line	:	PARKSIDE PLAZA 14 CALLE 12 SUITE 405
City	:	GUAYNABO
State	:	PR
Zip	:	00968-1704
Country	:	US
Telephone Number	:	787-522-4400
Fax Number	:	787-522-4401

Authorized Official
Title or Position	:	QUALITY DIRECTOR
Name	:	MR. JAVIER RODRIGUEZ
Credential	:	MS
Telephone Number	:	787-522-4400

Provider Enumeration Date	:	02/23/2011
Last Update Date	:	02/23/2011

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Directions to “COMPCARE DE PUERTO RICO ” Practice Location

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