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General NPI Number Information
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NPI Number | 1568087922
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Entity Type | Organization
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Legal Business Name | SGMJ MEDICAL CARE LLC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 39 CALLE MUNOZ RIVERA
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City | AGUAS BUENAS
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State | PR
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Zip | 00703-3233
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Country | US
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Telephone | 787-732-7424
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Fax | 787-732-7424
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Provider Business Mailing Address
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Address Line | PO BOX 4952 SIUTE 343
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City | CAGUAS
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State | PR
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Zip | 00726-4952
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Country | US
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Telephone | 787-732-7424
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Fax | 787-732-7424
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Authorized Official
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Title or Position | GENERAL PRACTICE
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Name | DR. EDWIN BONILLA GONZALEZ
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Credential | MD
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Telephone | 787-378-4017
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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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