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NPI Code Detail

MEDICARE: PPL MEDICAL CSP

MEDICARE: PPL MEDICAL CSP
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
1101YM0800XMental Health Counselor9828PR
2261Q00000XClinic/Center9686PR
32084P0800XPsychiatry Physician
4207RC0000XCardiovascular Disease Physician

General Provider Information

NPI Number : 1942435094
Entity Type Code : Organization
Provider Name (Legal Business Name) : PPL MEDICAL CSP
Provider Business Mailing Address
First Line : 100 GRAND BULEVARD PASEOS
Second Line : SUITE 112 MSC 333
City : SAN JUAN
State : PR
Zip : 00926-5955
Country : US
Telephone Number : 787-779-0484
Fax Number : 787-779-3065
Provider Business Practice Location Address
First Line : 68 SANTA CRUZ ST.
Second Line : SUITE 405
City : BAYAMON
State : PR
Zip : 00961-7036
Country : US
Telephone Number : 787-779-0484
Fax Number : 787-779-3065
Authorized Official
Title or Position : PRESIDENT
Name : DR. DOMINGO A. PEREZ
Credential : M.D.
Telephone Number : 787-779-0484
Provider Enumeration Date : 05/19/2009
Last Update Date : 04/30/2014

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Directions to “PPL MEDICAL CSP ” Practice Location

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