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General NPI Number Information
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NPI Number | 1962364919
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Entity Type | Organization
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Legal Business Name | BAM PUERTO RICO
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Dates
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Enumeration Date | 11/28/2025
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 452 AVE HOSTOS
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City | SAN JUAN
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State | PR
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Zip | 00918-3062
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Country | US
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Telephone | 787-410-9201
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Fax |
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Provider Business Mailing Address
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Address Line | 452 AVE HOSTOS
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City | SAN JUAN
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State | PR
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Zip | 00918-3062
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Country | US
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Telephone | 787-410-9201
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Fax |
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Authorized Official
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Title or Position | NUTRITIONIST
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Name | MICHELLE CARRILLO RUSSE
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Credential | LND
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Telephone | 787-510-9452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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