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General NPI Number Information
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NPI Number | 1649477928
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Entity Type | Organization
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Legal Business Name | GLG PREVENTIVE MEDICINE CENTER,PSC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | SAN GERMAN MEDICAL PLAZA SUITE 202 RD #2 KM 176
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City | SAN GERMAN
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State | PR
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Zip | 00683
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Country | US
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Telephone | 787-264-2124
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 923
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City | HORMIGUEROS
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State | PR
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Zip | 00660-0923
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Country | US
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Telephone | 787-264-2124
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GERMAN LUIS GONZALEZ GONZALEZ
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Credential |
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Telephone | 787-264-2124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 16660
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License Number State | PR
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