Provider Demographics
NPI:1558818484
Name:PR HEALTHCARE MANAGEMENT GROUP
Entity Type:Organization
Organization Name:PR HEALTHCARE MANAGEMENT GROUP
Other - Org Name:NAGUABO MEDICAL MALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:EMILIO
Authorized Official - Last Name:NEGRON JUDICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-637-6274
Mailing Address - Street 1:PO BOX 2598
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-2598
Mailing Address - Country:US
Mailing Address - Phone:787-637-6274
Mailing Address - Fax:
Practice Address - Street 1:CARR 31 KM. 4.0
Practice Address - Street 2:
Practice Address - City:NAGUABO
Practice Address - State:PR
Practice Address - Zip Code:00718
Practice Address - Country:US
Practice Address - Phone:787-874-3125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR57686261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHH671AOtherPTAN