MEDICARE: L. A PRIMARY CARE & SPECIALTY 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	207Q00000X	Family Medicine Physician	09645	PR

General Provider Information

NPI Number	:	1730531534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L. A PRIMARY CARE & SPECIALTY GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 11395
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00922-1395
Country	:	US
Telephone Number	:	787-226-6359
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CALLE DEL MUELLE
Second Line	:	CAPITOLIO PLAZA TORRE 1 1503
City	:	SAN JUAN
State	:	PR
Zip	:	00901-2616
Country	:	US
Telephone Number	:	787-226-6359
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RAMON LUIS LOPEZ ACOSTA
Credential	:	M.D.
Telephone Number	:	787-226-6359

Provider Enumeration Date	:	07/06/2016
Last Update Date	:	07/06/2016

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