Healthcare Provider Details

I. General information

NPI: 1730342122
Provider Name (Legal Business Name): CG SPECIALIZED MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 AVE DE DIEGO SEIN MEDICAL PLAZA SUITE 2
SAN JUAN PR
00921-3036
US

IV. Provider business mailing address

35 JC BORBON PMB 353 STE 67
GUAYNABO PR
00969-5375
US

V. Phone/Fax

Practice location:
  • Phone: 787-630-0563
  • Fax: 787-993-1993
Mailing address:
  • Phone: 787-630-0563
  • Fax: 787-993-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number15786
License Number StatePR

VIII. Authorized Official

Name: DR. CESAR G GOMEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-630-0563