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General NPI Number Information
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NPI Number | 1558748798
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Entity Type | Organization
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Legal Business Name | LRC MEDICAL PROFESSIONAL SERVICES LLC
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 5 CALLE GERONIMO MARTINEZ
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City | AIBONITO
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State | PR
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Zip | 00705-3660
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Country | US
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Telephone | 787-735-7859
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Fax | 787-954-7501
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Provider Business Mailing Address
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Address Line | PO BOX 2000
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City | AIBONITO
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State | PR
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Zip | 00705-2000
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Country | US
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Telephone | 787-735-7859
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Fax | 787-954-7501
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS ROBERTO CANAS
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Credential | MD
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Telephone | 787-735-7859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 5047
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License Number State | PR
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