Provider Demographics
NPI:1750454526
Name:PUERTO RICO HEALTH CARE GROUP
Entity Type:Organization
Organization Name:PUERTO RICO HEALTH CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR MEDICO
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOPEZ DEL POZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-841-2777
Mailing Address - Street 1:8169 CALLE CONCORDIA
Mailing Address - Street 2:SUITE 312 CONDOMINIO SAN VICENTE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1563
Mailing Address - Country:US
Mailing Address - Phone:787-841-2777
Mailing Address - Fax:787-848-0007
Practice Address - Street 1:8169 CALLE CONCORDIA
Practice Address - Street 2:SUITE 312 CONDOMINIO SAN VICENTE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1563
Practice Address - Country:US
Practice Address - Phone:787-841-2777
Practice Address - Fax:787-848-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0081480Medicare ID - Type Unspecified