Healthcare Provider Details

I. General information

NPI: 1205516366
Provider Name (Legal Business Name): EMERGE PBC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 AVE MUNOZ RIVERA STE 303
SAN JUAN PR
00925-2103
US

IV. Provider business mailing address

PO BOX 70344
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 939-330-1109
  • Fax: 866-379-9205
Mailing address:
  • Phone: 939-330-1109
  • Fax: 866-379-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIBEL CAMPOS RIVERA
Title or Position: PRESIDENT
Credential: MD MSC MBA
Phone: 787-436-8857