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General NPI Number Information
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NPI Number | 1124617444
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Entity Type | Organization
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Legal Business Name | CENTRO DE MEDICINA FAMILIAR LLC
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 03/31/2021
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Provider Practice Location Address
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Address Line | A4 CALLE GARCIA DE LA NOC
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City | RIO GRANDE
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State | PR
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Zip | 00745-2859
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Country | US
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Telephone | 787-888-0576
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Fax | 939-221-2393
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Provider Business Mailing Address
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Address Line | PO BOX 2220
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City | RIO GRANDE
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State | PR
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Zip | 00745-2225
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Country | US
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Telephone | 787-888-0576
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Fax | 939-221-2393
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Authorized Official
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Title or Position | MEDICINE DOCTOR
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Name | ROBERTO DURAND ROLON
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Credential | MD
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Telephone | 787-888-0576
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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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