Provider Demographics
NPI:1144875725
Name:FAMED PUERTO RICO
Entity type:Organization
Organization Name:FAMED PUERTO RICO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ COLON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:939-232-8923
Mailing Address - Street 1:E8 MARGARITA
Mailing Address - Street 2:FLAMINGO TERRACE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:939-232-8923
Mailing Address - Fax:
Practice Address - Street 1:CALLE JOSE C VAZQUEZ
Practice Address - Street 2:HOSPITAL GENERAL MENONITA
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:939-232-8923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty