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General NPI Number Information
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NPI Number | 1154912723
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Entity Type | Organization
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Legal Business Name | DOCTORIS MEDICAL GROUP CSP
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 01/27/2021
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Provider Practice Location Address
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Address Line | CARR. PR 3 KM 1 HM 9 EAST MEDICAL & PROFESSIONAL CENTER SUITE
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City | CANOVAS
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State | PR
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Zip | 00729
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Country | US
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Telephone | 787-256-5555
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Fax | 787-256-5454
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Provider Business Mailing Address
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Address Line | PO BOX 2379
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City | CANOVANAS
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State | PR
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Zip | 00729-2379
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Country | US
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Telephone | 787-256-5555
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Fax | 787-256-5454
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EDGAR N QUINTERO MALDONADO
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Credential | MD
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Telephone | 787-256-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RA0002X
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Taxonomy Name | Adult Congenital Heart Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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