Provider Demographics
NPI:1215040936
Name:GRUPO MEDICO ENMANUEL CSP
Entity Type:Organization
Organization Name:GRUPO MEDICO ENMANUEL CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:ESTEBAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ ASTACIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-299-3803
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-0489
Mailing Address - Country:US
Mailing Address - Phone:787-857-0300
Mailing Address - Fax:787-857-0800
Practice Address - Street 1:CARRETERA 152 KM 8.0
Practice Address - Street 2:BO. QUEBRADILLAS
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-857-0300
Practice Address - Fax:787-857-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084395Medicare ID - Type UnspecifiedMEDICAL SERVICE