MEDICARE: ACTION MEDICAL

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	261Q00000X	Clinic/Center	17940	PR
2	261QP2300X	Primary Care Clinic/Center	17940	PR
3	291U00000X	Clinical Medical Laboratory	17940	PR

General Provider Information

NPI Number	:	1326369679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTION MEDICAL

Provider Business Mailing Address
First Line	:	109 CALLE GUAYAMA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-4512
Country	:	US
Telephone Number	:	787-692-7000
Fax Number	:	787-754-9911

Provider Business Practice Location Address
First Line	:	109 CALLE GUAYAMA
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00917-4512
Country	:	US
Telephone Number	:	787-692-7000
Fax Number	:	787-754-9911

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	FELIX ALBERTO RODRIGUEZ
Credential	:	ATTORNEY
Telephone Number	:	787-692-7000

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/22/2010

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Directions to “ACTION MEDICAL ” Practice Location

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