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General NPI Number Information
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NPI Number | 1669917142
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Entity Type | Organization
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Legal Business Name | GRUPO MEDICO DE PR
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 12/20/2016
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Provider Practice Location Address
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Address Line | C92 URB ROLLING HILLS BRASIL
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-530-5975
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8914 PLAZA CAROLINA STATION
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City | CAROLINA
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State | PR
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Zip | 00988-8914
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Country | US
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Telephone | 787-530-5975
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZORAIDA VELAZQUEZ
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Credential |
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Telephone | 787-530-5975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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