Healthcare Provider Details

I. General information

NPI: 1215903992
Provider Name (Legal Business Name): GRUPO MEDICO GERIATRICO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B7 CALLE SANTA CRUZ
BAYAMON PR
00961-6902
US

IV. Provider business mailing address

B7 CALLE SANTA CRUZ
BAYAMON PR
00961-6902
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-9196
  • Fax: 787-625-6124
Mailing address:
  • Phone: 787-780-9196
  • Fax: 787-625-6124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ILIA E ZAYAS-TORO
Title or Position: CEO
Credential: MD, MPH
Phone: 787-780-9196