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General NPI Number Information
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NPI Number | 1992855746
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Entity Type | Organization
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Legal Business Name | EL MEDICO VISITANTE...,P.S.C.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 12/11/2012
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Provider Practice Location Address
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Address Line | 951 AVE AMERICO MIRANDA REPARTO METROPOLITANO
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City | SAN JUAN
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State | PR
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Zip | 00921-2801
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Country | US
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Telephone | 787-385-4924
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Fax | 787-771-5151
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Provider Business Mailing Address
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Address Line | PO BOX 364422
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City | SAN JUAN
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State | PR
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Zip | 00936-4422
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Country | US
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Telephone | 787-385-4924
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Fax | 787-771-5151
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Authorized Official
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Title or Position | PRESIDENTE
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Name | DR. ROBERTO ROSSO
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Credential | MD
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Telephone | 787-385-4924
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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 | PR
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