Healthcare Provider Details

I. General information

NPI: 1255997979
Provider Name (Legal Business Name): FACILIDADES MEDICAS ASOCIADAS CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 AVE FONT MARTELO STE 1
HUMACAO PR
00791-3346
US

IV. Provider business mailing address

PO BOX 9185
HUMACAO PR
00792-9185
US

V. Phone/Fax

Practice location:
  • Phone: 787-285-0655
  • Fax:
Mailing address:
  • Phone: 787-285-0655
  • Fax: 787-285-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ITZIANETTE ORTIZ
Title or Position: PROVIDER EXECUTIVE
Credential:
Phone: 787-619-7380