Provider Demographics
NPI:1669776035
Name:JUNCOS AGUAS BUENAS CAGUAS MEDICAL SERVICES
Entity type:Organization
Organization Name:JUNCOS AGUAS BUENAS CAGUAS MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-745-1077
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-0722
Mailing Address - Country:US
Mailing Address - Phone:787-745-1077
Mailing Address - Fax:787-703-2725
Practice Address - Street 1:RAFAEL CORDERO , TROCHE CORNER 2
Practice Address - Street 2:ANTIGUO CDT
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-1077
Practice Address - Fax:787-703-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8611208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty