Provider Demographics
NPI:1518600196
Name:MT MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:MT MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:DIAZ PARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-245-8883
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0488
Mailing Address - Country:US
Mailing Address - Phone:787-328-4444
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 118.3 INT
Practice Address - Street 2:18 REPARTO RIOLLANO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0060
Practice Address - Country:US
Practice Address - Phone:787-245-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service