Provider Demographics
NPI:1043897473
Name:CENTRO DE MEDICINA AVANZADA DE RIO GRANDE LLC
Entity Type:Organization
Organization Name:CENTRO DE MEDICINA AVANZADA DE RIO GRANDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-409-6430
Mailing Address - Street 1:URB VILLAS DE RIO GRANDE
Mailing Address - Street 2:C1 AVE AGUSTIN PEREZ ANDINO
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-888-7722
Mailing Address - Fax:
Practice Address - Street 1:URB VILLAS DE RIO GRANDE
Practice Address - Street 2:C1 AVE AGUSTIN PEREZ ANDINO
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-888-7722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty