Healthcare Provider Details

I. General information

NPI: 1134826506
Provider Name (Legal Business Name): GRUPO GERIATRICO DEL NORTE PFC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRUPO GERIATRICO DEL NORTE Q1 COND VILLAS DE LA PLAYA 1, C CONDONINIO GERIATRICO
DORADO PR
00646
US

IV. Provider business mailing address

PO BOX 1506
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-0671
  • Fax:
Mailing address:
  • Phone: 787-354-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DERIC LOPEZ RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-854-0671