Healthcare Provider Details

I. General information

NPI: 1164569604
Provider Name (Legal Business Name): MILLENIUM MEDICAL EMERGENCY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL SAN JUAN BAUTISTA URB TURABO GARDENS CARR 172
CAGUAS PR
00725-0000
US

IV. Provider business mailing address

PMB 171 BOX 4956
CAGUAS PR
00726-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-653-0550
  • Fax: 787-745-0708
Mailing address:
  • Phone: 787-745-0708
  • Fax: 787-745-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number12308
License Number StatePR

VIII. Authorized Official

Name: DR. GUILLERMO F CAMPOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-745-0708