Provider Demographics
NPI:1598374415
Name:BEYOND CARE DOCTOR GROUP CSP
Entity Type:Organization
Organization Name:BEYOND CARE DOCTOR GROUP CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED DELEGATE
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ARMANDO
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-921-5151
Mailing Address - Street 1:PMB-78 PO BOX 30400
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-921-5151
Mailing Address - Fax:787-921-5150
Practice Address - Street 1:BO COTTO NORTE CARR 670 KM 3.2
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-921-5151
Practice Address - Fax:787-921-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty