Healthcare Provider Details

I. General information

NPI: 1154629616
Provider Name (Legal Business Name): STRATEGIC MEDICAL MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 CALLE FONT MARTELO
HUMACAO PR
00791-3229
US

IV. Provider business mailing address

PO BOX 428
HUMACAO PR
00792-0428
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-0886
  • Fax: 787-852-0280
Mailing address:
  • Phone: 787-852-0886
  • Fax: 787-852-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AGUSTIN JUAN LOPEZ- COVAS
Title or Position: PRESIDENT
Credential: MD
Phone: 787-852-0886