Healthcare Provider Details

I. General information

NPI: 1598385049
Provider Name (Legal Business Name): MEDIEXPRESO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA HUCAR C6 CALLE ALMENDRO
SAN JUAN PR
00920
US

IV. Provider business mailing address

1342 AVE ROOSEVELT
SAN JUAN PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-380-1692
  • Fax:
Mailing address:
  • Phone: 787-380-1692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE NEGRON PEREZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-548-5380