Healthcare Provider Details

I. General information

NPI: 1407823495
Provider Name (Legal Business Name): ORGANIZACION DE MEDICOS ESPECIALITA Y GENERALES ASOCIADOS C S P OMEGA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#114 CALLE SANTIAGO VEVE SUITE 101
SAN GERMAN PR
00683-4163
US

IV. Provider business mailing address

#114 CALLE SANTIAGO VEVE SUITE 101
SAN GERMAN PR
00683-4163
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-3910
  • Fax: 787-264-0379
Mailing address:
  • Phone: 787-892-3910
  • Fax: 787-264-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. MIGUEL PEREZ BONILLA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-892-3910