Healthcare Provider Details

I. General information

NPI: 1871154906
Provider Name (Legal Business Name): NORTHEASTERN MEDICAL NETWORK L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124-8 AVE ROBERTO CLEMENTE
CAROLINA PR
00985
US

IV. Provider business mailing address

PO BOX 3628
CAROLINA PR
00984-3628
US

V. Phone/Fax

Practice location:
  • Phone: 787-750-4920
  • Fax: 787-276-4275
Mailing address:
  • Phone: 787-750-4920
  • Fax: 787-276-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE F HESS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-642-3232