Provider Demographics
NPI:1386853950
Name:GRUPO DE MEDICOS VISITANTES DEL OESTE,CSP
Entity Type:Organization
Organization Name:GRUPO DE MEDICOS VISITANTES DEL OESTE,CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-831-5479
Mailing Address - Street 1:PO BOX 3030
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3030
Mailing Address - Country:US
Mailing Address - Phone:787-831-5479
Mailing Address - Fax:787-831-5479
Practice Address - Street 1:52 CALLE DE DIEGO W
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4733
Practice Address - Country:US
Practice Address - Phone:787-831-5479
Practice Address - Fax:787-831-5479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15132208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4426OtherREGISTER