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General NPI Number Information
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NPI Number | 1013313931
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Entity Type | Organization
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Legal Business Name | MEDICO EN TU CASA
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 730 CALLE JULIO ANDINO URB VILLA PRADES
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City | SAN JUAN
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State | PR
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Zip | 00924-2252
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Country | US
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Telephone | 787-550-6747
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Fax | 787-550-6747
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Provider Business Mailing Address
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Address Line | PO BOX 31017
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City | SAN JUAN
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State | PR
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Zip | 00929-2017
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Country | US
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Telephone | 787-550-6747
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Fax | 787-550-6747
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMMY CARABALLO
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Credential | MD
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Telephone | 787-550-6747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 17157
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License Number State | PR
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