Healthcare Provider Details

I. General information

NPI: 1972134344
Provider Name (Legal Business Name): FENIX MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVE LAUREL
BAYAMON PR
00956-4816
US

IV. Provider business mailing address

PO BOX 275
BAYAMON PR
00960-0275
US

V. Phone/Fax

Practice location:
  • Phone: 787-506-4161
  • Fax: 787-286-7572
Mailing address:
  • Phone: 787-506-4161
  • Fax: 787-286-7572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAREN MARIE RIVERA
Title or Position: GENERAL MANAGER
Credential:
Phone: 787-506-4161