Healthcare Provider Details

I. General information

NPI: 1992030431
Provider Name (Legal Business Name): MEDI EX CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ARZUAGA 112 SUITE 605
SAN JUAN PR
00925-3316
US

IV. Provider business mailing address

ARZUAGA 112 SUITE 605
SAN JUAN PR
00925-3316
US

V. Phone/Fax

Practice location:
  • Phone: 787-646-0202
  • Fax: 787-763-0200
Mailing address:
  • Phone: 787-646-0202
  • Fax: 787-763-0200

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: DR. JUAN ANDUJAR
Title or Position: DOCTOR
Credential: 7876460202
Phone: 787-646-0202