Healthcare Provider Details

I. General information

NPI: 1861314924
Provider Name (Legal Business Name): GOLF MEDICAL SERVICES CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 CALLE HOSTOS
SANTA ISABEL PR
00757-2660
US

IV. Provider business mailing address

URB ESTANCIAS DEL GOLF CALLE MIGUEL RIVERA TEXIDOR 110
PONCE PR
00730
US

V. Phone/Fax

Practice location:
  • Phone: 787-240-3128
  • Fax:
Mailing address:
  • Phone: 787-240-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: WILFREDO PAOLI LOPEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-240-3128