Healthcare Provider Details

I. General information

NPI: 1619009529
Provider Name (Legal Business Name): CENTRO FAMILIAR MEDICINA AVANZADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B1 CALLE LOPE FLORES URBANIZACION PARADIS
CAGUAS PR
00726-0000
US

IV. Provider business mailing address

PO BOX 1388
CAGUAS PR
00726-1388
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-5790
  • Fax: 787-746-5790
Mailing address:
  • Phone: 787-746-5790
  • Fax: 787-746-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE M RODRIGUEZ
Title or Position: PRESIDENTE
Credential: M.D.
Phone: 787-746-5790