Provider Demographics
NPI:1750509154
Name:GROUPO MEDICO 340 CSP
Entity Type:Organization
Organization Name:GROUPO MEDICO 340 CSP
Other - Org Name:NO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONGAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-278-1062
Mailing Address - Street 1:349 CALLE MENDEZ VIGO
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-4917
Mailing Address - Country:US
Mailing Address - Phone:787-278-1062
Mailing Address - Fax:
Practice Address - Street 1:349 CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-4917
Practice Address - Country:US
Practice Address - Phone:787-278-1062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty