Healthcare Provider Details

I. General information

NPI: 1922339225
Provider Name (Legal Business Name): MEDICOS DE FAMILIA IMF, CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FD ROOSEVELT #1028 PUERTO NUEVO
SAN JUAN PR
00920-2904
US

IV. Provider business mailing address

CIUDAD JARDIN I CALLE AZALEA #92
TOA ALTA PR
00953-4845
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-8272
  • Fax: 787-783-0432
Mailing address:
  • Phone: 939-246-5011
  • Fax: 787-797-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ARIEL R. CRUZ IGARTUA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-380-9558