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General NPI Number Information
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NPI Number | 1750609319
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Entity Type | Organization
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Legal Business Name | ANGELORUM INC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | CARR 693 KM 13.8 SUITE 171 BO BRENAS
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City | VEGA ALTA
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State | PR
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Zip | 00692
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Country | US
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Telephone | 787-270-4747
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Fax | 787-270-4747
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Provider Business Mailing Address
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Address Line | PO BOX 356
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City | VEGA ALTA
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State | PR
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Zip | 00692-0356
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Country | US
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Telephone | 787-270-4747
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Fax | 787-270-4747
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS M GONZALEZ BERMUDEZMD
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Credential | MD
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Telephone | 787-270-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 57474
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 57474
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 57474
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License Number State | PR
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