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General NPI Number Information
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NPI Number | 1134598337
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Entity Type | Organization
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Legal Business Name | OFICINA MEDICA PRIMARIA DEL SUR CSP
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Dates
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Enumeration Date | 09/17/2015
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 65 INFANTERIA A1 LOCAL ANEXO REMA
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City | YAUCO
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State | PR
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Zip | 00698
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Country | US
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Telephone | 787-992-7199
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Fax | 787-992-7199
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Provider Business Mailing Address
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Address Line | PO BOX 446
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City | GUANICA
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State | PR
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Zip | 00653-0446
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Country | US
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Telephone | 787-992-7199
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Fax | 787-992-7199
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE E GONZALEZ MORENO
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Credential | MD
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Telephone | 787-690-2644
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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 | 15915
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 16881
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License Number State | PR
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