Provider Demographics
NPI:1093105256
Name:GRUPO MEDICO CAROLINA, LLC
Entity Type:Organization
Organization Name:GRUPO MEDICO CAROLINA, LLC
Other - Org Name:SERVICIOS SALUD MENTAL CAROLINA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROPRIETOR/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIOGENES
Authorized Official - Middle Name:O
Authorized Official - Last Name:ADAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-550-2467
Mailing Address - Street 1:PO BOX 9067
Mailing Address - Street 2:PLAZA CAROLINA STATION
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9067
Mailing Address - Country:US
Mailing Address - Phone:787-752-1979
Mailing Address - Fax:
Practice Address - Street 1:35-21 CALLE 16
Practice Address - Street 2:VILLA CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5440
Practice Address - Country:US
Practice Address - Phone:787-752-1979
Practice Address - Fax:787-998-3656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHY724AMedicare UPIN