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General NPI Number Information
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NPI Number | 1942427406
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Entity Type | Organization
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Legal Business Name | CENTRO DE MEDICINA FAMILIAR DR. JOSE J. LARRAURI
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 CALLE MARIO BRASCHI
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City | COAMO
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State | PR
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Zip | 00769-2501
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Country | US
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Telephone | 787-825-1224
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1883
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City | COAMO
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State | PR
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Zip | 00769-1883
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Country | US
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Telephone | 787-825-1224
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSE JESUS LARRAURI RENTA
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Credential | M.D.
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Telephone | 787-825-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 7382
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License Number State | PR
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