Provider Demographics
NPI:1326754706
Name:MD PREMIER HEALTH LLC
Entity Type:Organization
Organization Name:MD PREMIER HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RIGOBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-649-0848
Mailing Address - Street 1:97 PLAZA CARMEN
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-9128
Mailing Address - Country:US
Mailing Address - Phone:939-649-0848
Mailing Address - Fax:
Practice Address - Street 1:RIO LA PLATA MALL STE A3
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-1837
Practice Address - Country:US
Practice Address - Phone:787-870-2148
Practice Address - Fax:787-870-7431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty