Provider Demographics
NPI:1023383536
Name:L A PRIMARY CARE & SPECIALTY GROUP
Entity Type:Organization
Organization Name:L A PRIMARY CARE & SPECIALTY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:LOPEZ ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:787-226-6359
Mailing Address - Street 1:PO BOX 11395
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1395
Mailing Address - Country:US
Mailing Address - Phone:787-226-6359
Mailing Address - Fax:
Practice Address - Street 1:PORTALES DE ALTAMESA
Practice Address - Street 2:EDIFICIO #16, APT 1606
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4628
Practice Address - Country:US
Practice Address - Phone:787-226-6359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty