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General NPI Number Information
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NPI Number | 1104808807
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Entity Type | Organization
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Legal Business Name | CENTRO DE MEDICINE DE FAMILIA DE JUNCOS
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | PEDRO CRUZ MARGINAL #52 URB VALENCIA #1
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City | JUNCOS
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State | PR
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Zip | 00777
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Country | US
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Telephone | 787-734-4488
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Fax | 787-734-5460
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Provider Business Mailing Address
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Address Line | PO BOX 1569
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City | JUNCOS
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State | PR
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Zip | 00777-1569
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Country | US
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Telephone | 787-734-4488
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Fax | 787-734-5460
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Authorized Official
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Title or Position | MEDICODE FAMILIA PRESIDENTE
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Name | NANNETTE BERRIOS OCASIO
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Credential | MD
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Telephone | 787-734-4488
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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 | 9865
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License Number State |
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