Healthcare Provider Details

I. General information

NPI: 1992855746
Provider Name (Legal Business Name): EL MEDICO VISITANTE...,P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 AVE AMERICO MIRANDA REPARTO METROPOLITANO
SAN JUAN PR
00921-2801
US

IV. Provider business mailing address

PO BOX 364422
SAN JUAN PR
00936-4422
US

V. Phone/Fax

Practice location:
  • Phone: 787-385-4924
  • Fax: 787-771-5151
Mailing address:
  • Phone: 787-385-4924
  • Fax: 787-771-5151

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. ROBERTO ROSSO
Title or Position: PRESIDENTE
Credential: MD
Phone: 787-385-4924