Healthcare Provider Details

I. General information

NPI: 1780300608
Provider Name (Legal Business Name): GRYMAR PRIMARY CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 110 KM 28.5 BO AGUACATE
AGUADILLA PR
00603
US

IV. Provider business mailing address

HC 7 BOX 35867
AGUADILLA PR
00603-9442
US

V. Phone/Fax

Practice location:
  • Phone: 787-600-5054
  • Fax:
Mailing address:
  • Phone: 787-223-0153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GRISELY MORO ACEVEDO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-223-0153