Provider Demographics
NPI:1619471299
Name:CASSIOPEIA MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:CASSIOPEIA MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTURO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:ORTIZ ECHEVARRIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-692-8698
Mailing Address - Street 1:PASEO LAS OLAS
Mailing Address - Street 2:341 CALLE TIBURON
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4653
Mailing Address - Country:US
Mailing Address - Phone:787-692-8698
Mailing Address - Fax:
Practice Address - Street 1:PASEO LAS OLAS
Practice Address - Street 2:Q4 CALLE TIBURON
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4653
Practice Address - Country:US
Practice Address - Phone:787-692-8698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care