Healthcare Provider Details

I. General information

NPI: 1881867786
Provider Name (Legal Business Name): PAMG INDEPENDENT PRACTICE NETWORK CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. HOSTOS ESQUINA POWER NUM. 1266
PONCE PR
00731
US

IV. Provider business mailing address

PMB 282, 1575 MUNOZ RIVERA AVE.
PONCE PR
00717
US

V. Phone/Fax

Practice location:
  • Phone: 787-813-2324
  • Fax: 787-841-3908
Mailing address:
  • Phone: 787-813-2324
  • Fax: 787-841-3908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS A GONZALEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-813-2324