Provider Demographics
NPI:1831478130
Name:GRUPO MEDICO DE CAMUY, INC.
Entity Type:Organization
Organization Name:GRUPO MEDICO DE CAMUY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA NATAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-406-0172
Mailing Address - Street 1:PO BOX 9975
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-9975
Mailing Address - Country:US
Mailing Address - Phone:787-898-7990
Mailing Address - Fax:787-898-7990
Practice Address - Street 1:CARRETERA 129
Practice Address - Street 2:BARRIO BAYANEY KM 15.1
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-898-7990
Practice Address - Fax:787-898-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5972207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty