Provider Demographics
NPI:1508990342
Name:SAN PATRICIO MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:SAN PATRICIO MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMARILIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSERRATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-756-7078
Mailing Address - Street 1:AVE. LUIS MUNOZ RIVERA #652
Mailing Address - Street 2:EDIF. MONTE MALL, SUITE #2035
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-756-7078
Mailing Address - Fax:787-753-1269
Practice Address - Street 1:AVE. LUIS MUNOZ RIVERA #652
Practice Address - Street 2:EDIF. MONTE MALL, SUITE #2035
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-756-7078
Practice Address - Fax:787-753-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service