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General NPI Number Information
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NPI Number | 1083752778
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Entity Type | Organization
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Legal Business Name | CENTRO AMBULATORIO AUXILIO MUTUO
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | CARR. PR 199 KM.0.3 LAS CUMBRES CUPEY BAJO
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City | SAN JUAN
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State | PR
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Zip | 00928
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Country | US
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Telephone | 787-758-2000
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Fax | 787-771-7927
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Provider Business Mailing Address
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Address Line | PO BOX 191227
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City | SAN JUAN
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State | PR
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Zip | 00919-1227
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Country | US
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Telephone | 787-758-2000
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Fax | 787-771-7927
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ORLANDO GONZALEZ
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Credential |
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Telephone | 787-758-2000
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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 | 104
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License Number State | PR
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