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General NPI Number Information
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NPI Number | 1023383536
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Entity Type | Organization
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Legal Business Name | L A PRIMARY CARE & SPECIALTY GROUP
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 03/16/2012
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Provider Practice Location Address
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Address Line | PORTALES DE ALTAMESA EDIFICIO #16, APT 1606
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City | SAN JUAN
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State | PR
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Zip | 00921-4628
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Country | US
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Telephone | 787-226-6359
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11395
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City | SAN JUAN
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State | PR
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Zip | 00922-1395
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Country | US
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Telephone | 787-226-6359
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAMON LUIS LOPEZ ACOSTA
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Credential | M. D.
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Telephone | 787-226-6359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 09645
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License Number State | PR
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