MEDICARE: DOCTORS EXPRESS CORP

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	207Q00000X	Family Medicine Physician
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1124379409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS EXPRESS CORP

Provider Business Mailing Address
First Line	:	1353 AVE LUIS VIGOREAUX
Second Line	:	PMB 677
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2715
Country	:	US
Telephone Number	:	787-599-5417
Fax Number	:	787-294-5559

Provider Business Practice Location Address
First Line	:	C5 CALLE GARDEN MDW
Second Line	:	GARDEN HILLS
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2607
Country	:	US
Telephone Number	:	787-599-5417
Fax Number	:	787-294-5559

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MRS. SHIRLEY ANN RIVERA IGLESIAS
Credential	:
Telephone Number	:	787-599-5417

Provider Enumeration Date	:	09/26/2012
Last Update Date	:	10/24/2012

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