Provider Demographics
NPI:1649239203
Name:GRIUPO MEDICO ESPECIALIZADO
Entity Type:Organization
Organization Name:GRIUPO MEDICO ESPECIALIZADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MILTON
Authorized Official - Last Name:SOLTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-726-0440
Mailing Address - Street 1:PO BOX 364367
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4367
Mailing Address - Country:US
Mailing Address - Phone:787-726-0440
Mailing Address - Fax:787-727-5574
Practice Address - Street 1:1801 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1900
Practice Address - Country:US
Practice Address - Phone:787-726-0440
Practice Address - Fax:787-727-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028028Medicare ID - Type Unspecified