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General NPI Number Information
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NPI Number | 1134539810
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Entity Type | Organization
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Legal Business Name | AM INTERMEDICAL LLC
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Dates
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Enumeration Date | 05/02/2014
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Last Update Date | 05/02/2014
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Provider Practice Location Address
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Address Line | 820 CALLE MOLUCAS
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City | SAN JUAN
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State | PR
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Zip | 00924-1723
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Country | US
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Telephone | 787-768-4278
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Fax | 787-769-2220
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Provider Business Mailing Address
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Address Line | PO BOX 29430
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City | SAN JUAN
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State | PR
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Zip | 00929-0430
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Country | US
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Telephone | 787-768-4278
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Fax | 787-769-2220
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. MELVA NYDIA GONZALEZ
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Credential | MD
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Telephone | 939-969-9051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13605
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License Number State | PR
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