Organization
GERIVITALITY HOLDINGS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAUDES ILEANA LUGO MORALES MD (PRESIDENT)
(787) 314-8430
Entity
Organization
Contact information
Practice address
38 CALLE AMISTAD STE 2B, LAJAS, PR 00667-2072
(787) 718-0566
(787) 652-4278
Mailing address
PO BOX 560, LAJAS, PR 00667-0560
(787) 718-0566
(787) 652-4278
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
04/16/2024
Last updated
12/28/2024
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