Provider Demographics
NPI:1689465908
Name:LEGAL MED PR LCC
Entity type:Organization
Organization Name:LEGAL MED PR LCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ANDUJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-342-7474
Mailing Address - Street 1:157 CALLE RUIZ BELVIS 157
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-4732
Mailing Address - Country:US
Mailing Address - Phone:787-342-7474
Mailing Address - Fax:
Practice Address - Street 1:157 CALLE RUIZ BELVIS 157
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4732
Practice Address - Country:US
Practice Address - Phone:787-342-7474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center