Healthcare Provider Details

I. General information

NPI: 1861172876
Provider Name (Legal Business Name): FPRM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PASEO SAN PABLO STE 410
BAYAMON PR
00961-7028
US

IV. Provider business mailing address

100 PASEO SAN PABLO STE 410
BAYAMON PR
00961-7028
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-0970
  • Fax: 787-780-1660
Mailing address:
  • Phone: 787-780-0970
  • Fax: 787-780-1660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA NICOLE MAYMI-CASTRODAD
Title or Position: OWNER
Credential: MD
Phone: 787-647-3682