Provider Demographics
NPI:1891773347
Name:ESG GROUP LLC
Entity Type:Organization
Organization Name:ESG GROUP LLC
Other - Org Name:LABORATORIO CLINICO SAN CRISTOBAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-374-5715
Mailing Address - Street 1:3 CALLE BARCELO
Mailing Address - Street 2:STE 217 PLAZA SAN CRISTOBAL
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1709
Mailing Address - Country:US
Mailing Address - Phone:787-857-7777
Mailing Address - Fax:787-857-3792
Practice Address - Street 1:3 CALLE BARCELO
Practice Address - Street 2:SUITE 217 PLAZA SAN CRISTOBAL
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1709
Practice Address - Country:US
Practice Address - Phone:787-857-7777
Practice Address - Fax:787-857-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR806291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038287Medicare PIN