Healthcare Provider Details

I. General information

NPI: 1427351774
Provider Name (Legal Business Name): FR-MO MEDICAL GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METRO MEDICAL CENTER SUITE 701 PISO 7
BAYAMON PUERTO RICO
00956
UM

IV. Provider business mailing address

CALLE 1 K1 MANSIONES DE VILLA NOVA
SAN JUAN PR
00926-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-395-7085
  • Fax: 787-395-7090
Mailing address:
  • Phone: 787-395-7085
  • Fax: 787-395-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number14159
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number13326
License Number StatePR

VIII. Authorized Official

Name: FERDINAND RIVERA ORTIZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-359-2516