Healthcare Provider Details

I. General information

NPI: 1801452834
Provider Name (Legal Business Name): MEDIKUS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 05/19/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CARR 2 LUIS MOLINA
BARCELONETA PR
00617
US

IV. Provider business mailing address

1043 CALLE CARITE VALLES DEL LAGO
CAGUAS PR
00725-7645
US

V. Phone/Fax

Practice location:
  • Phone: 787-645-9010
  • Fax:
Mailing address:
  • Phone: 787-645-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KEYLA DIAZ
Title or Position: CEO
Credential: MD
Phone: 787-645-9010