Healthcare Provider Details

I. General information

NPI: 1164889838
Provider Name (Legal Business Name): TR MEDICAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CALLE I EXTENSION HERMANAS DAVILA
BAYAMON PR
00960-0000
US

IV. Provider business mailing address

PO BOX 926
BAYAMON PR
00960-0926
US

V. Phone/Fax

Practice location:
  • Phone: 787-785-6766
  • Fax:
Mailing address:
  • Phone: 787-785-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number3396
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number12858
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number13339
License Number StatePR

VIII. Authorized Official

Name: MR. LUIS ROSARIO VARGAS
Title or Position: TREASURER
Credential: M.D
Phone: 787-785-1228