Provider Demographics
NPI:1043420359
Name:ASOCIACION DE MEDICOS GENERALISTAS DE COROZAL
Entity Type:Organization
Organization Name:ASOCIACION DE MEDICOS GENERALISTAS DE COROZAL
Other - Org Name:AGCIPA346
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORITZ CALDERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-859-6452
Mailing Address - Street 1:PO BOX 94000 PMB 108
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-859-5434
Mailing Address - Fax:787-859-6452
Practice Address - Street 1:CALLE LAS MERCEDES #23
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-5434
Practice Address - Fax:787-859-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6333302R00000X
PR6237302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization