Provider Demographics
NPI:1649398116
Name:APD MEDICAL GROUP
Entity Type:Organization
Organization Name:APD MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEJANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS VISSEPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-243-2984
Mailing Address - Street 1:1151 CALLE 4 SE
Mailing Address - Street 2:CAPARRA TERRACE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1734
Mailing Address - Country:US
Mailing Address - Phone:787-243-2984
Mailing Address - Fax:787-283-8711
Practice Address - Street 1:CARRETERA # 2 KM 68.1
Practice Address - Street 2:BO. CERCADILLO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-815-3923
Practice Address - Fax:787-283-8711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center