MEDICARE: MEDICO XPRESO MULTI GROUP LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1346970712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICO XPRESO MULTI GROUP LLC

Provider Business Mailing Address
First Line	:	688 CALLE MAR DEL NORTE
Second Line	:
City	:	DORADO
State	:	PR
Zip	:	00646-4530
Country	:	US
Telephone Number	:	787-942-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	1790 AV. LAS LOMAS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-942-3232
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KEYRA NICOLE RIVERA HUREL
Credential	:
Telephone Number	:	787-459-5556

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	06/04/2024

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