Healthcare Provider Details

I. General information

NPI: 1669680054
Provider Name (Legal Business Name): ASOMANTE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 723 KM. 0.1 BO. ASOMANTE
AIBONITO PR
00705
US

IV. Provider business mailing address

26 CALLE LEPANTO
SAN JUAN PR
00926-1905
US

V. Phone/Fax

Practice location:
  • Phone: 787-991-1790
  • Fax:
Mailing address:
  • Phone: 787-991-1790
  • 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: MR. JOSE L MUNDO
Title or Position: PRESIDENT
Credential:
Phone: 787-717-5655