Healthcare Provider Details

I. General information

NPI: 1508396243
Provider Name (Legal Business Name): FIGUEROA AMARO MEDICAL GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

893 EIDER STREET COUNTRY CLUB
SAN JUAN PR
00924-2371
US

IV. Provider business mailing address

PO BOX 29454
SAN JUAN PR
00929-0454
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-6996
  • Fax:
Mailing address:
  • Phone: 787-768-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10987
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number10297
License Number StatePR

VIII. Authorized Official

Name: WALTER FIGUEROA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-768-6996