Healthcare Provider Details

I. General information

NPI: 1407215585
Provider Name (Legal Business Name): PHYSICIANS HMO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAROLINA SHOPPING COUNTI SUITE 201A
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 193044
SAN JUAN PR
00919-3044
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-8758
  • Fax: 844-759-2968
Mailing address:
  • Phone: 787-767-8758
  • Fax: 787-250-9265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number StatePR

VIII. Authorized Official

Name: MARIBEL LOPEZ
Title or Position: ASSISTANT/PRESIDENT
Credential:
Phone: 787-767-8758