Healthcare Provider Details

I. General information

NPI: 1255051181
Provider Name (Legal Business Name): PLENUS MEDICAL GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/31/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAS FLORES DE MONTEHIEDRA CALLE ROMERILLO 674
SAN JUAN PR
00926
US

IV. Provider business mailing address

LAS FLORES DE MONTEHIEDRA CALLE ROMERILLO 674
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-667-4218
  • Fax:
Mailing address:
  • Phone: 787-667-4218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARITZA SALCEDO
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-667-4218