Provider Demographics
NPI:1407823495
Name:ORGANIZACION DE MEDICOS ESPECIALITA Y GENERALES ASOCIADOS C S P OMEGA
Entity Type:Organization
Organization Name:ORGANIZACION DE MEDICOS ESPECIALITA Y GENERALES ASOCIADOS C S P OMEGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ BONILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-892-3910
Mailing Address - Street 1:#114 CALLE SANTIAGO VEVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4163
Mailing Address - Country:US
Mailing Address - Phone:787-892-3910
Mailing Address - Fax:787-264-0379
Practice Address - Street 1:#114 CALLE SANTIAGO VEVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4163
Practice Address - Country:US
Practice Address - Phone:787-892-3910
Practice Address - Fax:787-264-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0017071Medicare UPIN