Healthcare Provider Details

I. General information

NPI: 1396950283
Provider Name (Legal Business Name): PRIMARY CARE & OB GYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON SUITE 710
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

735 AVE PONCE DE LEON SUITE 710
SAN JUAN PR
00917-5022
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-1777
  • Fax: 787-753-1820
Mailing address:
  • Phone: 787-753-1777
  • Fax: 787-753-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number13060
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE R FLORES CABAN
Title or Position: PRESIDENTE
Credential: M.D.
Phone: 787-753-1777