# GALENOS SELECTOS DE PUERTO RICO, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679876718
- **Authorized official:** DR. EFRAIN DIEGO GONZALEZ M.D. (PRESIDENT)
- **Authorized official phone:** (916) 990-4204

## Contact information

- **Practice address:** PLAZOLETA PONCE CASH AND CARRY MORELL CAMPOS, LOCAL 4, PONCE, PR 00732
- **Practice address phone:** (787) 284-1566
- **Practice address fax:** (787) 290-6689
- **Mailing address:** PMB 261 BOX 7105, PONCE, PUERTO RICO 00732
- **Mailing address phone:** (787) 284-1566
- **Mailing address fax:** (787) 290-6689

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 11B2134 | PR | Yes |

## Other

- **Enumeration date:** 12/13/2010
- **Last updated:** 12/13/2010