Provider Demographics
NPI:1164781357
Name:MCA HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:MCA HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:ABDIEL
Authorized Official - Last Name:CANDELAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:787-778-0315
Mailing Address - Street 1:PO BOX 6598
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5598
Mailing Address - Country:US
Mailing Address - Phone:787-778-0315
Mailing Address - Fax:787-778-0330
Practice Address - Street 1:CALLE SANTA CRUZ #20
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-778-0315
Practice Address - Fax:787-778-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization