Healthcare Provider Details

I. General information

NPI: 1336317189
Provider Name (Legal Business Name): METRO - MED C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET 21 53-2 LAS LOMAS
SAN JUAN PR
00921
US

IV. Provider business mailing address

STREET 21 53-2 LAS LOMAS
SAN JUAN PR
00921
US

V. Phone/Fax

Practice location:
  • Phone: 787-782-4615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LUIS ALFONSO RIVERA
Title or Position: PRESIDENTE
Credential:
Phone: 787-782-4615