Healthcare Provider Details

I. General information

NPI: 1457666901
Provider Name (Legal Business Name): MEDICOS ESPECIALIZADOS DE PUERTO RICO, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CALLE WASHINGTON SUITE 104
SAN JUAN PR
00907-1510
US

IV. Provider business mailing address

PO BOX 16698
SAN JUAN PR
00908-6698
US

V. Phone/Fax

Practice location:
  • Phone: 305-926-0593
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number15828
License Number StatePR

VIII. Authorized Official

Name: ALEJANDRO PORRATA
Title or Position: PHYSICIAN
Credential: MD
Phone: 305-926-5036