Healthcare Provider Details

I. General information

NPI: 1649239203
Provider Name (Legal Business Name): GRIUPO MEDICO ESPECIALIZADO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 AVE PONCE DE LEON
SANTURCE PR
00909-1900
US

IV. Provider business mailing address

PO BOX 364367
SAN JUAN PR
00936-4367
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-0440
  • Fax: 787-727-5574
Mailing address:
  • Phone: 787-726-0440
  • Fax: 787-727-5574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE MILTON SOLTERO
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-726-0440