Healthcare Provider Details

I. General information

NPI: 1447291380
Provider Name (Legal Business Name): JULIO MARIN CONCEPCION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B6 CALLE H URB. MONTE BRISAS
FAJARDO PR
00738-3352
US

IV. Provider business mailing address

PO BOX 2022
FAJARDO PR
00738-2022
US

V. Phone/Fax

Practice location:
  • Phone: 787-247-1714
  • Fax: 787-655-0679
Mailing address:
  • Phone: 787-247-1714
  • Fax: 787-655-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15957
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: