Provider Demographics
NPI:1003039421
Name:CENTRAL PRIMARY CARE GROUP, INC.
Entity Type:Organization
Organization Name:CENTRAL PRIMARY CARE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE-ADMINISTRADOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GIOVANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-828-6456
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-2430
Mailing Address - Country:US
Mailing Address - Phone:787-828-6456
Mailing Address - Fax:787-828-6417
Practice Address - Street 1:13 CALLE GUILLERMO ESTEVES
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664-2430
Practice Address - Country:US
Practice Address - Phone:787-828-6456
Practice Address - Fax:787-828-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089342Medicare PIN