Provider Demographics
NPI:1013129444
Name:CIDRA EMERGENCY GROUP
Entity Type:Organization
Organization Name:CIDRA EMERGENCY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ BENABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-396-0816
Mailing Address - Street 1:114 AVE LUIS MUNOZ RIVERA S
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 AVE LUIS MUNOZ RIVERA S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4703
Practice Address - Country:US
Practice Address - Phone:787-396-0816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7390033OtherHUMANA PROVIDER NUMBER
PR7390033OtherHUMANA PROVIDER NUMBER
PR0083608Medicare ID - Type UnspecifiedPROVIDER NUMBER