Healthcare Provider Details

I. General information

NPI: 1922430958
Provider Name (Legal Business Name): CENTRO DE MEDICINA FAMILIAR ESPECIALIZADA C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 AVE MIGUEL MELENDEZ MUNOZ
CAYEY PR
00736-4609
US

IV. Provider business mailing address

PO BOX 372139
CAYEY PR
00737-2139
US

V. Phone/Fax

Practice location:
  • Phone: 787-263-3138
  • Fax: 787-263-2205
Mailing address:
  • Phone: 787-263-3138
  • Fax: 787-263-2205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16845
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number7535
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE RADAMES MUNIZ-MELENDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-263-3138