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General NPI Number Information
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NPI Number | 1104951623
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Entity Type | Organization
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Legal Business Name | GRUPO MEDICO LA AMISTAD, INC.
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 07/12/2013
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Provider Practice Location Address
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Address Line | CARR. 863 KM 2.0 BARRIO PAJAROS, SECTOR TRES CALLES
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-740-4240
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Fax | 787-740-4240
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Provider Business Mailing Address
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Address Line | HC-01 BOX 8017
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-740-4240
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Fax | 787-740-4240
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Authorized Official
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Title or Position | MD
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Name | GRETZA O. CASTRO CURET
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Credential | MD
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Telephone | 787-740-4240
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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 | 14,276
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License Number State | PR
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