MEDICARE: SAN PATRICIO MEDICAL GROUP 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1508990342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN PATRICIO MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	AVE. LUIS MUNOZ RIVERA #652
Second Line	:	EDIF. MONTE MALL, SUITE #2035
City	:	HATO REY
State	:	PR
Zip	:	00918
Country	:	US
Telephone Number	:	787-756-7078
Fax Number	:	787-753-1269

Provider Business Practice Location Address
First Line	:	AVE. LUIS MUNOZ RIVERA #652
Second Line	:	EDIF. MONTE MALL, SUITE #2035
City	:	HATO REY
State	:	PR
Zip	:	00918
Country	:	US
Telephone Number	:	787-756-7078
Fax Number	:	787-753-1269

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. AMARILIS MONSERRATE
Credential	:
Telephone Number	:	787-756-7078

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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