Healthcare Provider Details

I. General information

NPI: 1336346105
Provider Name (Legal Business Name): GRUPO ENT FACULTAD MEDICA HMSJ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AC31 CALLE 45 SANTA JUANITA
BAYAMON PR
00956-4753
US

IV. Provider business mailing address

PMB 101 BOX 70344 CMMS 101
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-2222
  • Fax: 787-765-4975
Mailing address:
  • Phone: 787-766-2222
  • Fax: 787-765-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. LISETTE PEREZ
Title or Position: DIRECTOR
Credential: M.D.
Phone: 787-766-2222