Healthcare Provider Details

I. General information

NPI: 1376202366
Provider Name (Legal Business Name): GSM-SALUD PRIMARIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 AVE PONCE DE LEON STE GM4
SAN JUAN PR
00909-1803
US

IV. Provider business mailing address

1353 AVE LUIS VIGOREAUX PMB 757
GUAYNABO PR
00966-2715
US

V. Phone/Fax

Practice location:
  • Phone: 787-910-0909
  • Fax: 888-588-0319
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VASCO EGUIA MOREDA
Title or Position: PRESIDENT OWNER
Credential:
Phone: 787-633-5263