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General NPI Number Information
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NPI Number | 1104252212
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Entity Type | Organization
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Legal Business Name | MEDIC HOME INFUSIONS
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 1056 CALLE FERROCARRIL
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City | RIO PIEDRAS
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State | PR
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Zip | 00925-3028
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Country | US
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Telephone | 787-449-7933
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Fax |
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Provider Business Mailing Address
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Address Line | 574 CALLE CABO H ALVERIO URB LA MERCED
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City | SAN JUAN
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State | PR
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Zip | 00918-3724
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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
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Name | LUIS ALEXIS ROMAN MARRERO
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Credential | M.D.
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Telephone | 787-296-0617
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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