Healthcare Provider Details

I. General information

NPI: 1932932712
Provider Name (Legal Business Name): QUEBRADILLAS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR NUM 2 KM 96.7 BO COCOS
QUEBRADILLAS PR
00678-9326
US

IV. Provider business mailing address

42818 CARR 482
QUEBRADILLAS PR
00678-9326
US

V. Phone/Fax

Practice location:
  • Phone: 787-420-2090
  • Fax: 787-500-2015
Mailing address:
  • Phone: 787-248-0180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN CARLOS CRUZ CRUZ
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 787-248-0180