Provider Demographics
NPI:1033236070
Name:GRUPO MEDICO DE LA MONTANA, INC.
Entity Type:Organization
Organization Name:GRUPO MEDICO DE LA MONTANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-738-3434
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1597
Mailing Address - Country:US
Mailing Address - Phone:787-761-0025
Mailing Address - Fax:787-292-7175
Practice Address - Street 1:162 AVE LUIS MUNOZ RIVERA S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4705
Practice Address - Country:US
Practice Address - Phone:787-738-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization