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General NPI Number Information
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NPI Number | 1871060178
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Entity Type | Organization
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Legal Business Name | SERVICIOS PRO MEDICO
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | URB MENDEZ A2 SUITE 3
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City | YABUCOA
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State | PR
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Zip | 00778
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Country | US
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Telephone | 787-590-7238
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 114
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City | GURABO
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State | PR
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Zip | 00778-0114
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Country | US
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Telephone | 787-590-7238
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHNNY MELVIN GONZALEZ
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Credential |
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Telephone | 787-590-7238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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