Healthcare Provider Details

I. General information

NPI: 1265732184
Provider Name (Legal Business Name): FAMILY MEDICINE GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ROBERTO CLEMENTE 124 #8 VILLA CAROLINA
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 3628
CAROLINA PR
00984-3628
US

V. Phone/Fax

Practice location:
  • Phone: 787-257-0709
  • Fax: 787-276-4275
Mailing address:
  • Phone: 787-257-0709
  • Fax: 787-276-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number237
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number10945
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7219
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number6414
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5799
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16321
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE HESS
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 787-257-0709