MEDICARE: CONVENTION HEALTH CENTER

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	207R00000X	Internal Medicine Physician
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1821374745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONVENTION HEALTH CENTER

Provider Business Mailing Address
First Line	:	PO BOX 7602
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-7602
Country	:	US
Telephone Number	:	787-457-0974
Fax Number	:	787-724-4513

Provider Business Practice Location Address
First Line	:	AVE FERNANDEZ JUNCOS
Second Line	:	#600
City	:	SAN JUAN
State	:	PR
Zip	:	00907-3181
Country	:	US
Telephone Number	:	787-969-3853
Fax Number	:

Authorized Official
Title or Position	:	CORPORATE EXECUTIVE OFFICER
Name	:	DR. JESUS MANUEL GALVEZ
Credential	:	MD
Telephone Number	:	787-457-0974

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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