Provider Demographics
NPI:1245427897
Name:GRUPO MEDICO COSTA ESTE INC.
Entity Type:Organization
Organization Name:GRUPO MEDICO COSTA ESTE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MUNTANER
Authorized Official - Suffix:
Authorized Official - Credentials:MD/
Authorized Official - Phone:787-860-3700
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-1001
Mailing Address - Country:US
Mailing Address - Phone:787-885-4446
Mailing Address - Fax:787-885-6129
Practice Address - Street 1:205 AVE LAURO PINERO
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2701
Practice Address - Country:US
Practice Address - Phone:787-885-4446
Practice Address - Fax:787-885-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9737261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care