=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861172876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FPRM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2023
-----------------------------------------------------
Last Update Date | 07/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PASEO SAN PABLO STE 410
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961-7028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-780-0970
-----------------------------------------------------
Fax | 787-780-1660
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 PASEO SAN PABLO STE 410
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00961-7028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-780-0970
-----------------------------------------------------
Fax | 787-780-1660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICIA NICOLE MAYMI-CASTRODAD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-647-3682
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------