Provider Demographics
NPI:1508025966
Name:GRUPO MEDICO IPA-341
Entity Type:Organization
Organization Name:GRUPO MEDICO IPA-341
Other - Org Name:GRUPOMEDICO IPA-341
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:ADMINISTATOR
Authorized Official - Phone:787-869-5421
Mailing Address - Street 1:56 CALLE GEORGETTI
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-3000
Mailing Address - Country:US
Mailing Address - Phone:787-869-5421
Mailing Address - Fax:787-869-5542
Practice Address - Street 1:56 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-3000
Practice Address - Country:US
Practice Address - Phone:787-869-5421
Practice Address - Fax:787-869-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service