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General NPI Number Information
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NPI Number | 1861363004
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Entity Type | Organization
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Legal Business Name | FUNDACION MI GRAN SUENO, INCORPORADO
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | CARR. 442 KM 1.5 INTERIOR BO. ESPINAL
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 787-252-6464
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Fax | 787-252-6464
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Provider Business Mailing Address
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Address Line | PO BOX 1595
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City | AGUADA
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State | PR
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Zip | 00602-1595
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Country | US
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Telephone | 787-431-6101
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Fax |
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Authorized Official
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Title or Position | FUNDADOR
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Name | LUIS A. QUINTANA MORENO
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Credential |
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Telephone | 787-431-6101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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