MEDICARE: EL MEDICO VISITANTE...,P.S.C.

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	302R00000X	Health Maintenance Organization		PR

General Provider Information

NPI Number	:	1992855746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL MEDICO VISITANTE...,P.S.C.

Provider Business Mailing Address
First Line	:	PO BOX 364422
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-4422
Country	:	US
Telephone Number	:	787-385-4924
Fax Number	:	787-771-5151

Provider Business Practice Location Address
First Line	:	951 AVE AMERICO MIRANDA
Second Line	:	REPARTO METROPOLITANO
City	:	SAN JUAN
State	:	PR
Zip	:	00921-2801
Country	:	US
Telephone Number	:	787-385-4924
Fax Number	:	787-771-5151

Authorized Official
Title or Position	:	PRESIDENTE
Name	:	DR. ROBERTO ROSSO
Credential	:	MD
Telephone Number	:	787-385-4924

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	12/11/2012

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