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General NPI Number Information
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NPI Number | 1417302464
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Entity Type | Organization
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Legal Business Name | AGD ENDOCRINOLOGY LLC
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Dates
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Enumeration Date | 04/27/2016
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Last Update Date | 04/27/2016
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Provider Practice Location Address
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Address Line | BS4 AVENIDA LAS AMERICAS URBANIZACION BAIROA
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City | CAGUAS
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State | PR
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Zip | 00725
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Country | US
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Telephone | 787-923-4892
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7163
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City | CAGUAS
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State | PR
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Zip | 00726-7163
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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
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Name | ANETTE GARCES DOMINGUEZ
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Credential | M.D
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Telephone | 787-923-4892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 19193
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License Number State | PR
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