Provider Demographics
NPI:1891682316
Name:PERFORMANCE SPORTS MED LLC
Entity type:Organization
Organization Name:PERFORMANCE SPORTS MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZALEZ VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, CAQSM
Authorized Official - Phone:787-404-0909
Mailing Address - Street 1:351 AVE HOSTOS
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-831-5831
Mailing Address - Fax:787-827-8020
Practice Address - Street 1:351 AVE HOSTOS
Practice Address - Street 2:SUITE 206
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-5831
Practice Address - Fax:787-827-8020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty