Healthcare Provider Details

I. General information

NPI: 1881091700
Provider Name (Legal Business Name): OPTIMAL MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

O-13 JOSE VILLARES AVE. URB DELGADO
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 4956 SUITE 1133
CAGUAS PR
00726-4956
US

V. Phone/Fax

Practice location:
  • Phone: 787-745-1702
  • Fax: 787-703-1320
Mailing address:
  • Phone: 787-745-1702
  • Fax: 787-703-1320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9691
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number8645
License Number StatePR

VIII. Authorized Official

Name: DR. GONZALO FALCON-CARO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-745-1702