Provider Demographics
NPI:1619188257
Name:MUNICIPIO DE RIO GRANDE
Entity Type:Organization
Organization Name:MUNICIPIO DE RIO GRANDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:LEBRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-809-1010
Mailing Address - Street 1:CALLE MANUEL PIMENTEL Y CASTRO #200
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745-0000
Mailing Address - Country:US
Mailing Address - Phone:787-809-1010
Mailing Address - Fax:
Practice Address - Street 1:CALLE MANUEL PIMENTEL Y CASTRO #200
Practice Address - Street 2:PUEBLO
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-0000
Practice Address - Country:US
Practice Address - Phone:787-809-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR97261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========Medicaid