Healthcare Provider Details

I. General information

NPI: 1023307915
Provider Name (Legal Business Name): GCM MEDICAL GROUP, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 AVE FERNANDEZ JUNCOS
SAN JUAN PR
00909-3004
US

IV. Provider business mailing address

PO BOX 13867
SAN JUAN PR
00908-3867
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-8396
  • Fax: 787-919-0640
Mailing address:
  • Phone: 787-726-8396
  • Fax: 787-919-0640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number16033
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number16033
License Number StatePR

VIII. Authorized Official

Name: DR. GREGORIO ANTONIO CORTES MAISONET
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-726-8396