Provider Demographics
NPI:1407092208
Name:GRUPO MEDICINA PRIMARIA DE COROZAL, INC.
Entity Type:Organization
Organization Name:GRUPO MEDICINA PRIMARIA DE COROZAL, INC.
Other - Org Name:GRUPO MEDICINA PRIMARIA DE COROZAL, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-859-6452
Mailing Address - Street 1:PMB 108 PO BOX 94000
Mailing Address - Street 2:
Mailing Address - City:COROZAL
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00783
Mailing Address - Country:UM
Mailing Address - Phone:787-859-6452
Mailing Address - Fax:787-859-6452
Practice Address - Street 1:23 CALLE LAS MERCEDES
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783-1924
Practice Address - Country:US
Practice Address - Phone:787-859-6452
Practice Address - Fax:787-859-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization