Healthcare Provider Details

I. General information

NPI: 1083610828
Provider Name (Legal Business Name): ALVARO REYMUNDE POSSO MD,FACP,FACG,AGAF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

EDIF PARRA STE 806 2225 PONCE BY PASS
PONCE PR
00717-1321
US

IV. Provider business mailing address

PO BOX 334069
PONCE PR
00733-4069
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-8212
  • Fax: 787-848-7979
Mailing address:
  • Phone: 787-259-8212
  • Fax: 787-848-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number207RG0100X
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: