Provider Demographics
NPI:1659735223
Name:MYO PERFUSION GROUP LLC
Entity Type:Organization
Organization Name:MYO PERFUSION GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANIBAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-538-4680
Mailing Address - Street 1:CALLE RIO JAJOME AK 16 URB RIO HONDO II
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-538-4680
Mailing Address - Fax:
Practice Address - Street 1:CALLE RIO JAJOME AK 16 URB RIO HONDO II
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-538-4680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy