Provider Demographics
NPI:1568087922
Name:SGMJ MEDICAL CARE LLC
Entity Type:Organization
Organization Name:SGMJ MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONILLA GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-378-4017
Mailing Address - Street 1:PO BOX 4952
Mailing Address - Street 2:SIUTE 343
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-4952
Mailing Address - Country:US
Mailing Address - Phone:787-732-7424
Mailing Address - Fax:787-732-7424
Practice Address - Street 1:39 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-3233
Practice Address - Country:US
Practice Address - Phone:787-732-7424
Practice Address - Fax:787-732-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR823035OtherDRIVER LINCEN