Healthcare Provider Details

I. General information

NPI: 1427495951
Provider Name (Legal Business Name): BAYAMON FAMILY & GERIATRIC MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ISABEL II OFIC. #107 EDIF. JOAQUIN MONTESINO
BAYAMON PR
00961
US

IV. Provider business mailing address

MONTE CLARO, PLAZA 17 ME-32 BAYAMON FAMILY & GERIATRIC MEDICAL CLINIC, LLC
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-5930
  • Fax: 787-780-5930
Mailing address:
  • Phone: 787-780-5930
  • Fax: 787-780-5930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEJANDRO A. MEDINA VILAR
Title or Position: MEDICO DE FAMILY
Credential:
Phone: 787-780-5930