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General NPI Number Information
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NPI Number | 1639997539
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Entity Type | Organization
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Legal Business Name | SAN PEDRO MEDICAL GROUP
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | URB CIARA DEL SOL CALLE CIARA DEL SUR # 35
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-346-7064
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Fax |
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Provider Business Mailing Address
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Address Line | URB CIARA DEL SOL CALLE CIARA DEL SUR # 35
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-346-7064
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. LENNY TUA
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Credential | MD
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Telephone | 787-346-7064
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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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