Provider Demographics
NPI:1346789260
Name:PUERTO RICO CONCIERGE & INTERNAL MEDICINE SERVICES
Entity Type:Organization
Organization Name:PUERTO RICO CONCIERGE & INTERNAL MEDICINE SERVICES
Other - Org Name:PR CONCIERGE & INTERNAL MEDICINE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLAZO PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-970-5277
Mailing Address - Street 1:315 CALLE MANUEL DOMENECH STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3513
Mailing Address - Country:US
Mailing Address - Phone:787-296-4949
Mailing Address - Fax:
Practice Address - Street 1:B35 CALLE ELLIOT VELEZ
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4615
Practice Address - Country:US
Practice Address - Phone:787-970-5277
Practice Address - Fax:877-991-8663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service