Healthcare Provider Details

I. General information

NPI: 1518599539
Provider Name (Legal Business Name): METRO HATO REY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 PONCE DE LEON AVE
SAN JUAN PR
00917
US

IV. Provider business mailing address

PO BOX 190828
SAN JUAN PR
00919
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-2323
  • Fax: 787-268-1162
Mailing address:
  • Phone: 787-641-2323
  • Fax: 787-268-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DOMINGO NEVAREZ RAMIREZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 787-641-2323