Healthcare Provider Details

I. General information

NPI: 1699406256
Provider Name (Legal Business Name): MAGALY DELACRUZ FROMETA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/23/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONDOMINIO DOS MARINAS 1 100 AVE. MARINA VW APART 1008
FAJARDO PR
00738
US

IV. Provider business mailing address

CONDOMINIO DOS MARINAS 1 100 AVE. MARINA VW APART 1008
FAJARDO PR
00738
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-1914
  • Fax:
Mailing address:
  • Phone: 305-776-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberF03220877
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: