Healthcare Provider Details

I. General information

NPI: 1912814559
Provider Name (Legal Business Name): BERRIOS MEDICINA DE FAMILIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 853 INT 185 BO. CEDROS
CAROLINA PR
00987
US

IV. Provider business mailing address

HC 3 BOX 12052
CAROLINA PR
00987-9617
US

V. Phone/Fax

Practice location:
  • Phone: 939-639-4876
  • Fax:
Mailing address:
  • Phone: 939-639-4876
  • Fax:

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: JACLISMAR BERRIOS-RIVERA
Title or Position: PRESIDENT
Credential: MD
Phone: 939-639-4876