Healthcare Provider Details

I. General information

NPI: 1962289678
Provider Name (Legal Business Name): MEDCITASFP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 ESTANCIAS DE SIERRA MAESTRA
ANASCO PR
00610
US

IV. Provider business mailing address

36 ESTANCIAS DE SIERRA MAESTRA
ANASCO PR
00610
US

V. Phone/Fax

Practice location:
  • Phone: 787-405-5866
  • Fax:
Mailing address:
  • Phone: 787-405-5866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: ROLANDO FLORES
Title or Position: PRESIDENT
Credential:
Phone: 787-405-5866