1407092208 NPI number — GRUPO MEDICINA PRIMARIA DE COROZAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407092208 NPI number — GRUPO MEDICINA PRIMARIA DE COROZAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GRUPO MEDICINA PRIMARIA DE COROZAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRUPO MEDICINA PRIMARIA DE COROZAL, INC.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407092208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PMB 108 PO BOX 94000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COROZAL
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00783
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-859-6452
Provider Business Mailing Address Fax Number:
787-859-6452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 CALLE LAS MERCEDES
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COROZAL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00783-1924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-859-6452
Provider Business Practice Location Address Fax Number:
787-859-6452
Provider Enumeration Date:
12/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ
Authorized Official First Name:
MIGUEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-859-6452

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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