Healthcare Provider Details

I. General information

NPI: 1518504349
Provider Name (Legal Business Name): FBOP METROPOLITAN DETENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 CARRETERA 28
GUAYNABO PR
00965
US

IV. Provider business mailing address

652 CARRETERA 28
GUAYNABO PR
00965
US

V. Phone/Fax

Practice location:
  • Phone: 787-749-4430
  • Fax: 787-775-7824
Mailing address:
  • Phone: 787-749-4430
  • Fax: 787-775-7824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IDARMIS PEREZ
Title or Position: CHIEF PHARMACIST
Credential: PHARMD
Phone: 787-475-7938