Healthcare Provider Details

I. General information

NPI: 1972941193
Provider Name (Legal Business Name): AFACRED MED PR CRL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR PR 21 BLOQUE S 3 11 URB LAS LOMAS
SAN JUAN PR
00921
US

IV. Provider business mailing address

PO BOX 2602
GUAYNABO PR
00970-2602
US

V. Phone/Fax

Practice location:
  • Phone: 939-249-3417
  • Fax:
Mailing address:
  • Phone: 787-633-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARIBEL GOMEZ-LOPEZ
Title or Position: PRESIDENT
Credential: MBA/HCM
Phone: 939-249-3417