Healthcare Provider Details

I. General information

NPI: 1053810770
Provider Name (Legal Business Name): MEDCONNECTPR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 CALLE LOIZA STE 401
SAN JUAN PR
00911-1865
US

IV. Provider business mailing address

16 CARRION CT SUITE 62
SAN JUAN PR
00911
US

V. Phone/Fax

Practice location:
  • Phone: 787-247-0595
  • Fax:
Mailing address:
  • Phone: 787-247-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE RAMON MARRERO
Title or Position: DIRECTOR
Credential:
Phone: 787-247-0595