Provider Demographics
NPI:1023451002
Name:GRUPO MEDICO CONCEPTO FISICO
Entity type:Organization
Organization Name:GRUPO MEDICO CONCEPTO FISICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARABALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-864-8471
Mailing Address - Street 1:PO BOX 900
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0900
Mailing Address - Country:US
Mailing Address - Phone:787-864-8471
Mailing Address - Fax:787-866-6558
Practice Address - Street 1:5 CALLE DUQUE
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-5507
Practice Address - Country:US
Practice Address - Phone:787-864-8471
Practice Address - Fax:787-866-6558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10944261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy