Healthcare Provider Details

I. General information

NPI: 1699722439
Provider Name (Legal Business Name): G4 MEDICAL OF PUERTO RICO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CALLE CORONEL COTTO LLANADAS
ISABELA PR
00662-4800
US

IV. Provider business mailing address

28 CALLE CORONEL COTTO LLANADAS
ISABELA PR
00662-4800
US

V. Phone/Fax

Practice location:
  • Phone: 787-830-6210
  • Fax: 787-830-6215
Mailing address:
  • Phone: 787-830-6210
  • Fax: 787-830-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LOURDES MARINA MORADI
Title or Position: PRESIDENT
Credential:
Phone: 787-830-6210