Provider Demographics
NPI:1316544018
Name:MEDICAL CONQUEST GROUP
Entity Type:Organization
Organization Name:MEDICAL CONQUEST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-231-6292
Mailing Address - Street 1:M35 CALLE WILSON
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3950
Mailing Address - Country:US
Mailing Address - Phone:939-231-6292
Mailing Address - Fax:
Practice Address - Street 1:M35 CALLE WILSON
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-3950
Practice Address - Country:US
Practice Address - Phone:939-231-6292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty