Provider Demographics
NPI:1114198413
Name:PRIMARY MEDICAL HEALTH GROUP, CORP.
Entity Type:Organization
Organization Name:PRIMARY MEDICAL HEALTH GROUP, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-252-2165
Mailing Address - Street 1:76 CALLE COLON
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-3114
Mailing Address - Country:US
Mailing Address - Phone:787-252-2165
Mailing Address - Fax:787-868-7258
Practice Address - Street 1:76 CALLE COLON
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3114
Practice Address - Country:US
Practice Address - Phone:787-252-2165
Practice Address - Fax:787-868-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty