Provider Demographics
NPI:1881091700
Name:OPTIMAL MEDICAL SERVICES
Entity type:Organization
Organization Name:OPTIMAL MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GONZALO
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCON-CARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-745-1702
Mailing Address - Street 1:PO BOX 4956
Mailing Address - Street 2:SUITE 1133
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4956
Mailing Address - Country:US
Mailing Address - Phone:787-745-1702
Mailing Address - Fax:787-703-1320
Practice Address - Street 1:O-13 JOSE VILLARES AVE.
Practice Address - Street 2:URB DELGADO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-745-1702
Practice Address - Fax:787-703-1320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8645208D00000X
PR9691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9691OtherLICENCE