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General NPI Number Information
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NPI Number | 1891682316
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Entity Type | Organization
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Legal Business Name | PERFORMANCE SPORTS MED LLC
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 351 AVE HOSTOS SUITE 206
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City | MAYAGUEZ
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State | PR
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Zip | 00680
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Country | US
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Telephone | 787-831-5831
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Fax | 787-827-8020
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Provider Business Mailing Address
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Address Line | 351 AVE HOSTOS SUITE 206
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City | MAYAGUEZ
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State | PR
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Zip | 00680
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Country | US
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Telephone | 787-831-5831
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Fax | 787-827-8020
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEJANDRA E GONZALEZ VEGA
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Credential | M.D., CAQSM
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Telephone | 787-404-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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