Healthcare Provider Details

I. General information

NPI: 1598374415
Provider Name (Legal Business Name): BEYOND CARE DOCTOR GROUP CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO COTTO NORTE CARR 670 KM 3.2
MANATI PR
00674
US

IV. Provider business mailing address

PMB-78 PO BOX 30400
MANATI PR
00674
US

V. Phone/Fax

Practice location:
  • Phone: 787-921-5151
  • Fax: 787-921-5150
Mailing address:
  • Phone: 787-921-5151
  • Fax: 787-921-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LUIS ARMANDO VEGA
Title or Position: AUTHORIZED DELEGATE
Credential:
Phone: 787-921-5151