Basic Information
| Provider Information | |||||||||
| NPI: | 1245953454 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONCEPCION | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | ANTONIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CARR. 129, KM 1.0 AV. SAN LUIS, | ||||||||
| Address2: | |||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507272 | ||||||||
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| Practice Location | |||||||||
| Address1: | CRRETERA 129, KM 1.0 AV SAN LUIS | ||||||||
| Address2: | |||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507272 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2022 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 16034-I | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.