MEDICARE: GRUPO MEDICO FAMILIAR

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	:	1659606879
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRUPO MEDICO FAMILIAR

Provider Business Mailing Address
First Line	:	1700 SANTA AGUEDA
Second Line	:	URB SAN GERARDO
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-754-1059
Fax Number	:	787-754-1059

Provider Business Practice Location Address
First Line	:	1700 SANTA AGUEDA
Second Line	:	URB SAN GERARDO
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-754-1059
Fax Number	:	787-754-1059

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MICHAEL F. SOLER
Credential	:	MD
Telephone Number	:	787-754-1059

Provider Enumeration Date	:	10/06/2009
Last Update Date	:	10/06/2009

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