Provider Demographics
NPI:1942418769
Name:GRUPO MEDICO DE OROCOVIS
Entity Type:Organization
Organization Name:GRUPO MEDICO DE OROCOVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BENGOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-281-0810
Mailing Address - Street 1:1551 CALLE ALDA
Mailing Address - Street 2:SUITE 201 URB. CARIBE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2709
Mailing Address - Country:US
Mailing Address - Phone:787-281-0810
Mailing Address - Fax:787-474-3051
Practice Address - Street 1:1551 CALLE ALDA
Practice Address - Street 2:SUITE 201 URB. CARIBE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2709
Practice Address - Country:US
Practice Address - Phone:787-281-0810
Practice Address - Fax:787-474-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service