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General NPI Number Information
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NPI Number | 1386739860
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Entity Type | Organization
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Legal Business Name | GERIATRIC HEALTHCARE GROUP, P.S.C.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 54 STREET S.E./ #1276 URB. LA RIVIERA
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City | SAN JUAN
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State | PR
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Zip | 00921
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Country | US
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Telephone | 787-381-0247
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Fax | 787-755-9005
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Provider Business Mailing Address
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Address Line | P.O. BOX 194288
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City | SAN JUAN
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State | PR
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Zip | 00919-4288
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Country | US
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Telephone | 787-381-0247
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Fax | 787-755-9005
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE PAOLI-BRUNO
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Credential | M.D.
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Telephone | 787-381-0247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12292
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License Number State | PR
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