Healthcare Provider Details

I. General information

NPI: 1629895107
Provider Name (Legal Business Name): LIFEMD PUERTO RICO PATIENT MEDICAL CARE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CALLE 1 STE 400
GUAYNABO PR
00968-1760
US

IV. Provider business mailing address

236 5TH AVE STE 400
NEW YORK NY
10001-7606
US

V. Phone/Fax

Practice location:
  • Phone: 800-852-1575
  • Fax:
Mailing address:
  • Phone: 800-852-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC YECIES
Title or Position: GENERAL COUNSEL
Credential:
Phone: 646-263-3680