Healthcare Provider Details

I. General information

NPI: 1114679248
Provider Name (Legal Business Name): METRO-EASTERN PHYSICIAN GROUP L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 CALLE MUNOZ RIVERA
JUNCOS PR
00777-3149
US

IV. Provider business mailing address

PO BOX 1945
JUNCOS PR
00777-1945
US

V. Phone/Fax

Practice location:
  • Phone: 787-893-3411
  • Fax:
Mailing address:
  • Phone: 787-893-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL JOSE ORTIZ BUSTILLO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-893-3411