Healthcare Provider Details

I. General information

NPI: 1164286266
Provider Name (Legal Business Name): DOCTOR XPRESS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 25 DE JULIO #10
GUANICA PR
00653-0065
US

IV. Provider business mailing address

URB. HACIENDA CONSTANCIA CALLE VISTAMONTE # 787
HORMIGUEROS PR
00660
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-2006
  • Fax:
Mailing address:
  • Phone: 787-692-7604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN ALEJANDRO VEGA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-692-7604