Provider Demographics
NPI:1114341112
Name:WRR ELITE MEDICAL GROUP CSP
Entity Type:Organization
Organization Name:WRR ELITE MEDICAL GROUP CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-376-4168
Mailing Address - Street 1:PO BOX 2939
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-2939
Mailing Address - Country:US
Mailing Address - Phone:787-376-4168
Mailing Address - Fax:787-999-0077
Practice Address - Street 1:CALLE 531 QJ17
Practice Address - Street 2:COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-376-4168
Practice Address - Fax:787-999-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17652261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care