Provider Demographics
NPI:1568680981
Name:GRUPO EXCLUSIVO MEDICO ASOCIADO DEL SUR
Entity Type:Organization
Organization Name:GRUPO EXCLUSIVO MEDICO ASOCIADO DEL SUR
Other - Org Name:GEMAS
Other - Org Type:Other Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:VELASCO-CERVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-267-2811
Mailing Address - Street 1:PO BOX 3004
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3004
Mailing Address - Country:US
Mailing Address - Phone:787-267-2811
Mailing Address - Fax:787-267-1964
Practice Address - Street 1:40 CALLE 25 DE JULIO
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3601
Practice Address - Country:US
Practice Address - Phone:787-267-2811
Practice Address - Fax:787-267-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherEIN