Healthcare Provider Details

I. General information

NPI: 1902164973
Provider Name (Legal Business Name): PROFESSIONAL EMERGENCY MEDICAL SERVICES CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUITE 501 BAYAMON MEDICAL PLAZA
BAYAMON PR
00956-7200
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 647
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-0145
  • Fax:
Mailing address:
  • Phone: 787-399-2774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANNE M MARIN
Title or Position: SECRETARY
Credential: M.D.
Phone: 787-399-2774