Provider Demographics
NPI:1093926834
Name:DE MEDICOS PRIMARIOS, CORP.
Entity Type:Organization
Organization Name:DE MEDICOS PRIMARIOS, CORP.
Other - Org Name:CORPORACION MEDICO PRIMARIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-845-6000
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-0816
Mailing Address - Country:US
Mailing Address - Phone:787-845-6000
Mailing Address - Fax:787-845-8014
Practice Address - Street 1:14 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-2632
Practice Address - Country:US
Practice Address - Phone:787-845-6000
Practice Address - Fax:787-845-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12337302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088847Medicare ID - Type Unspecified