Provider Demographics
NPI:1235346438
Name:GRUPO MEDICO IPA 555
Entity Type:Organization
Organization Name:GRUPO MEDICO IPA 555
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LUZARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-721-0279
Mailing Address - Street 1:PO BOX 9023558
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-3558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN FRANCISCO 405
Practice Address - Street 2:SUITE 2-C
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00902
Practice Address - Country:US
Practice Address - Phone:787-721-0279
Practice Address - Fax:787-721-0279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization