Healthcare Provider Details

I. General information

NPI: 1285948182
Provider Name (Legal Business Name): MU MEDICOS UNIDOS DE PUERTO RICO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CALLE LEPANTO
SAN JUAN PR
00926-1905
US

IV. Provider business mailing address

25 CALLE LEPANTO
SAN JUAN PR
00926-1905
US

V. Phone/Fax

Practice location:
  • Phone: 787-717-5655
  • Fax: 787-282-0238
Mailing address:
  • Phone: 787-717-5655
  • Fax: 787-282-0238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE L MUNDO
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-717-5655