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General NPI Number Information
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NPI Number | 1124252101
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Entity Type | Organization
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Legal Business Name | PAMG INDEPENDENT PRACTICE NETWORK CORP.
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 1266 AVE. HOSTOS ESQ. POWER
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City | PONCE
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State | PR
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Zip | 00731
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Country | US
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Telephone | 787-813-2324
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Fax | 787-841-3908
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Provider Business Mailing Address
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Address Line | PMB 282 1575 MUNOZ RIVERA AVE.
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City | PONCE
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State | PR
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Zip | 00717
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Country | US
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Telephone | 787-813-2324
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Fax | 787-841-3908
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARLOS ALBERTO GONZALEZ BERDECIA
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Credential | M.D.
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Telephone | 787-813-2324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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