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General NPI Number Information
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NPI Number | 1376202366
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Entity Type | Organization
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Legal Business Name | GSM-SALUD PRIMARIA, LLC
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Dates
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Enumeration Date | 12/17/2021
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Last Update Date | 12/21/2021
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Provider Practice Location Address
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Address Line | 1607 AVE PONCE DE LEON STE GM4
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City | SAN JUAN
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State | PR
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Zip | 00909-1803
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Country | US
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Telephone | 787-910-0909
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Fax | 888-588-0319
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Provider Business Mailing Address
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Address Line | 1353 AVE LUIS VIGOREAUX PMB 757
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City | GUAYNABO
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State | PR
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Zip | 00966-2715
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. VASCO EGUIA MOREDA
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Credential |
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Telephone | 787-633-5263
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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