Healthcare Provider Details

I. General information

NPI: 1982197513
Provider Name (Legal Business Name): AMG PUERTO RICO, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 AVE CONSTITUCION
SAN JUAN PR
00901-2304
US

IV. Provider business mailing address

PO BOX 16804
SAN JUAN PR
00908-6804
US

V. Phone/Fax

Practice location:
  • Phone: 787-289-7814
  • Fax:
Mailing address:
  • Phone: 787-289-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARCILIO ALVARADO
Title or Position: PRESIDENT
Credential:
Phone: 787-289-7814