Provider Demographics
NPI:1528226776
Name:CIDRA ER GROUP INC
Entity Type:Organization
Organization Name:CIDRA ER GROUP INC
Other - Org Name:CIDRA ER GROUP INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-614-5231
Mailing Address - Street 1:PMB 659 NUMERO 138
Mailing Address - Street 2:AVENIDA WINSTON CHURCHILL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-614-5231
Mailing Address - Fax:
Practice Address - Street 1:CALLE FRANCISCO CRUZ HADDOCK NUM 5
Practice Address - Street 2:URB FERNANDEZ
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-614-5231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUAN C. RAMOS MARTINEZ
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicare PIN