Healthcare Provider Details

I. General information

NPI: 1285794966
Provider Name (Legal Business Name): CENTRO DE MEDICINA DE FAMILIA DE CAYEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CALLE BARBOSA S
CAYEY PR
00736-4726
US

IV. Provider business mailing address

PO BOX 1267
CAYEY PR
00737-1267
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-3088
  • Fax: 787-738-0551
Mailing address:
  • Phone: 787-738-3088
  • Fax: 787-738-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10261
License Number StatePR

VIII. Authorized Official

Name: DR. MAYRA LOPEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 787-738-3088