Provider Demographics
NPI:1205006087
Name:GRUPO NORTE DORADO, CSP
Entity Type:Organization
Organization Name:GRUPO NORTE DORADO, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUARBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-878-1839
Mailing Address - Street 1:BO. CARRIZALES
Mailing Address - Street 2:CARR 493 KM.0.5
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BO. CARRIZALES
Practice Address - Street 2:CARR 493 KM.0.5
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-878-1839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization