Provider Demographics
NPI:1053687590
Name:NORTH PRIMARY CARE MEDICAL GROUP, CORP
Entity Type:Organization
Organization Name:NORTH PRIMARY CARE MEDICAL GROUP, CORP
Other - Org Name:NPC MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:PASTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-667-8654
Mailing Address - Street 1:PMB236 100 GRAND PASEOS BLV 112
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-8654
Mailing Address - Country:US
Mailing Address - Phone:787-755-3902
Mailing Address - Fax:787-755-3902
Practice Address - Street 1:PMB236 100 GRAND PASEOS BLV 112
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-8654
Practice Address - Country:US
Practice Address - Phone:787-755-3902
Practice Address - Fax:787-755-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN