Healthcare Provider Details

I. General information

NPI: 1932317740
Provider Name (Legal Business Name): GIPECD MEDICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOULEVARD MONROIG Y38 4FA SECC. LEVITTOWN
TOA BAJA PR
00949
US

IV. Provider business mailing address

PO BOX 51519
TOA BAJA PR
00950-1519
US

V. Phone/Fax

Practice location:
  • Phone: 787-200-0324
  • Fax: 787-200-0325
Mailing address:
  • Phone: 787-200-0324
  • Fax: 787-200-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14329
License Number StatePR

VIII. Authorized Official

Name: MR. CARLOS A BUXO
Title or Position: PRESIDENT
Credential: MD
Phone: 787-200-0324