Provider Demographics
NPI:1013202258
Name:GRUPO MEDICO MULTIDISCIPLINARIO INC
Entity Type:Organization
Organization Name:GRUPO MEDICO MULTIDISCIPLINARIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVERA MOJICA
Authorized Official - Suffix:
Authorized Official - Credentials:LIC
Authorized Official - Phone:787-536-6946
Mailing Address - Street 1:3604 MONTECILLO COURT
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3604 MONTECILLO COURT
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-536-6946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care