Provider Demographics
NPI:1073926713
Name:PPL MEDICAL CSP
Entity Type:Organization
Organization Name:PPL MEDICAL CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRINCIPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-779-0484
Mailing Address - Street 1:100 GRAND BOULEVARD PASEOS SUITE 112
Mailing Address - Street 2:MSC 333
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5955
Mailing Address - Country:US
Mailing Address - Phone:787-779-0484
Mailing Address - Fax:787-779-3065
Practice Address - Street 1:68 CALLE SANTA CRUZ
Practice Address - Street 2:SUITE 405
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7036
Practice Address - Country:US
Practice Address - Phone:787-779-0484
Practice Address - Fax:787-779-3065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR82164Medicare UPIN