Provider Demographics
NPI:1760598981
Name:GMG DIAGNOSTIC INC
Entity Type:Organization
Organization Name:GMG DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-795-8116
Mailing Address - Street 1:90 AVE RIO HONDO STE 333 PMB STE
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3105
Mailing Address - Country:US
Mailing Address - Phone:787-795-8116
Mailing Address - Fax:787-795-8116
Practice Address - Street 1:AVE. AMALIA PAOLI SF15
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-795-8116
Practice Address - Fax:787-795-8116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089165Medicare ID - Type UnspecifiedIDTF