Healthcare Provider Details

I. General information

NPI: 1942044672
Provider Name (Legal Business Name): V.M. GERIATRA PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/29/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 AVE DE DIEGO
SAN JUAN PR
00921-3043
US

IV. Provider business mailing address

106 CALLE PITIRRE
SAN JUAN PR
00926-7100
US

V. Phone/Fax

Practice location:
  • Phone: 787-630-1259
  • Fax:
Mailing address:
  • Phone: 787-478-9604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: VALERIA CRISTINA MORELL CARRASQUILLO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-478-9604