Provider Demographics
NPI:1558682849
Name:RGD MEDICAL GROUP
Entity Type:Organization
Organization Name:RGD MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:ANDUJAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-989-5593
Mailing Address - Street 1:109 CALLE GUAYAMA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-4512
Mailing Address - Country:US
Mailing Address - Phone:787-989-5593
Mailing Address - Fax:
Practice Address - Street 1:109 CALLE GUAYAMA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-4512
Practice Address - Country:US
Practice Address - Phone:787-989-5593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
PR17940261QC1500X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health