Provider Demographics
NPI:1104808807
Name:CENTRO DE MEDICINE DE FAMILIA DE JUNCOS
Entity type:Organization
Organization Name:CENTRO DE MEDICINE DE FAMILIA DE JUNCOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICODE FAMILIA PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:NANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRIOS OCASIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-734-4488
Mailing Address - Street 1:PO BOX 1569
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1569
Mailing Address - Country:US
Mailing Address - Phone:787-734-4488
Mailing Address - Fax:787-734-5460
Practice Address - Street 1:PEDRO CRUZ MARGINAL #52 URB VALENCIA #1
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-734-4488
Practice Address - Fax:787-734-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
067845OtherCRUZ AZUL
500097SEOtherMMM
6660041OtherHUMANA
PE2342OtherPALIC
34135OtherPROSSAM
3471OtherPREFERRED MEDICAL CHOICE
8230OtherIMC
200228OtherUTI
82139OtherTRIPLE S
3609865OtherUIA
8230OtherIMC
6660041OtherHUMANA