Healthcare Provider Details

I. General information

NPI: 1982920062
Provider Name (Legal Business Name): MEDCAN,PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A8 AVE 65 INFANTERIA URB. SAN AGUSTIN
SAN JUAN PR
00926-1834
US

IV. Provider business mailing address

A8 AVE 65 INFANTERIA URB. SAN AGUSTIN
SAN JUAN PR
00926-1834
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-3010
  • Fax: 787-740-3009
Mailing address:
  • Phone: 787-740-3010
  • Fax: 787-740-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. GISELLE MARTINEZ
Title or Position: FACTURADORA
Credential:
Phone: 787-740-3010