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General NPI Number Information
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NPI Number | 1841070208
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Entity Type | Organization
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Legal Business Name | PROACTIVEMED LLC
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | URBANIZACION PEREYO CALLE ORION 9
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-998-2040
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Fax | 787-266-8423
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Provider Business Mailing Address
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Address Line | PO BOX 1327
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City | GURABO
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State | PR
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Zip | 00778-1327
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Country | US
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Telephone | 787-998-2040
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Fax |
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | PEDRO D SANTIAGO LUGO
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Credential | MD
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Telephone | 787-243-6966
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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