Provider Demographics
NPI:1275266074
Name:SENIOR PRIMARY MEDICINE INC
Entity Type:Organization
Organization Name:SENIOR PRIMARY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:GREGMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-274-9637
Mailing Address - Street 1:HC 71 BOX 3305
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9532
Mailing Address - Country:US
Mailing Address - Phone:787-452-1572
Mailing Address - Fax:
Practice Address - Street 1:NARANJITO SHOOPING VILLAGE
Practice Address - Street 2:BO.CEDRO ARRIBA CARR 152 KM
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:939-274-9637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-08
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty