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General NPI Number Information
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NPI Number | 1972941193
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Entity Type | Organization
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Legal Business Name | AFACRED MED PR CRL
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 06/12/2013
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Provider Practice Location Address
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Address Line | CARR PR 21 BLOQUE S 3 11 URB LAS LOMAS
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City | SAN JUAN
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State | PR
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Zip | 00921
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Country | US
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Telephone | 939-249-3417
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2602
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City | GUAYNABO
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State | PR
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Zip | 00970-2602
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Country | US
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Telephone | 787-633-6919
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIBEL GOMEZ-LOPEZ
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Credential | MBA/HCM
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Telephone | 939-249-3417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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