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General NPI Number Information
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NPI Number | 1649609470
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Entity Type | Organization
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Legal Business Name | MMV INTERNAL MEDICINE P.S.C.
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 143 AVE UNIV INTERAMERICANA
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City | SAN GERMAN
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State | PR
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Zip | 00683-4320
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Country | US
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Telephone | 787-892-6060
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Fax | 787-264-5755
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Provider Business Mailing Address
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Address Line | PO BOX 326
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City | SAN GERMAN
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State | PR
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Zip | 00683-0326
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Country | US
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Telephone | 787-892-6060
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Fax | 787-264-5755
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARITZA MARTINEZ VARGAS
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Credential | MD
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Telephone | 787-892-6060
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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 | 7568
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License Number State | PR
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