MEDICARE: GES CDT DR. MANUEL QUEVEDO BAEZ

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	3336C0003X	Community/Retail Pharmacy	09-F2468	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1835G0000X	OTHER	PR	PHARMACY

General Provider Information

NPI Number	:	1245363852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GES CDT DR. MANUEL QUEVEDO BAEZ

Provider Business Mailing Address
First Line	:	PO BOX 193044
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-3044
Country	:	US
Telephone Number	:	787-767-8758
Fax Number	:

Provider Business Practice Location Address
First Line	:	359 CALLE SAN AGUSTIN
Second Line	:	PUERTA DE TIERRA
City	:	SAN JUAN
State	:	PR
Zip	:	00901-2908
Country	:	US
Telephone Number	:	787-723-6057
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAUL VILLALOBOS
Credential	:
Telephone Number	:	787-767-8758

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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