MEDICARE: PAMG SELECTO, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	07-B-2318	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003110107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMG SELECTO, INC

Provider Business Mailing Address
First Line	:	1266 AVE HOSTOS
Second Line	:	ESQ. POWER
City	:	PONCE
State	:	PR
Zip	:	00717-0947
Country	:	US
Telephone Number	:	787-813-2325
Fax Number	:	787-841-3908

Provider Business Practice Location Address
First Line	:	1266 AVE HOSTOS
Second Line	:	ESQ. POWER
City	:	PONCE
State	:	PR
Zip	:	00717-0947
Country	:	US
Telephone Number	:	787-813-2325
Fax Number	:	787-841-3908

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. LUIS M IRIZARRY
Credential	:	M.D.
Telephone Number	:	787-813-2325

Provider Enumeration Date	:	01/04/2011
Last Update Date	:	01/04/2011

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Directions to “PAMG SELECTO, INC ” Practice Location

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