Healthcare Provider Details

I. General information

NPI: 1225166077
Provider Name (Legal Business Name): CENTRO MEDICINA FAMILIA Y GERIATRIA RIO PIEDRAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 CALLE WILLIAM JONES
SAN JUAN PR
00925-3441
US

IV. Provider business mailing address

1107 CALLE WILLIAM JONES
SAN JUAN PR
00925-3441
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-8018
  • Fax: 787-753-5801
Mailing address:
  • Phone: 787-764-8018
  • Fax: 787-753-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. CARLOS M GARCIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-764-8018