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General NPI Number Information
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NPI Number | 1407946585
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Entity Type | Organization
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Legal Business Name | FJB MEDICAL GROUP
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1427 CALLE AMERICO SALAS
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City | SAN JUAN
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State | PR
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Zip | 00909-2140
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Country | US
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Telephone | 787-603-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 1427 CALLE AMERICO SALAS
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City | SAN JUAN
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State | PR
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Zip | 00909-2140
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Country | US
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Telephone | 787-603-6868
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | FERNANDO ENRIQUE VISBAL
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Credential |
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Telephone | 787-603-6868
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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 | 164164
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License Number State | PR
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