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General NPI Number Information
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NPI Number | 1053644757
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Entity Type | Organization
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Legal Business Name | CLINICA GEORGETTI INC.
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Dates
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Enumeration Date | 09/12/2009
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Last Update Date | 09/12/2009
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Provider Practice Location Address
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Address Line | 58 CALLE GEORGETTI
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City | VEGA ALTA
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State | PR
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Zip | 00692-7096
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Country | US
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Telephone | 787-883-1379
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Fax | 787-883-1360
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Provider Business Mailing Address
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Address Line | PO BOX 3022
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City | VEGA ALTA
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State | PR
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Zip | 00692-3022
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Country | US
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Telephone | 787-883-1379
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Fax | 787-883-1360
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | DR. GUSTAVO CEDENO
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Credential | M.D.
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Telephone | 787-883-1379
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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 | 12098
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License Number State | PR
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