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General NPI Number Information
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NPI Number | 1013202258
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Entity Type | Organization
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Legal Business Name | GRUPO MEDICO MULTIDISCIPLINARIO INC
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 3604 MONTECILLO COURT
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone | 787-536-6946
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Fax |
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Provider Business Mailing Address
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Address Line | 3604 MONTECILLO COURT
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City | TRUJILLO ALTO
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State | PR
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Zip | 00976
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & OWNER
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Name | RUBEN J RIVERA MOJICA
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Credential | LIC
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Telephone | 787-536-6946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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