Provider Demographics
NPI:1134598337
Name:OFICINA MEDICA PRIMARIA DEL SUR CSP
Entity type:Organization
Organization Name:OFICINA MEDICA PRIMARIA DEL SUR CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZALEZ MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-690-2644
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-0446
Mailing Address - Country:US
Mailing Address - Phone:787-992-7199
Mailing Address - Fax:787-992-7199
Practice Address - Street 1:65 INFANTERIA A1
Practice Address - Street 2:LOCAL ANEXO REMA
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-992-7199
Practice Address - Fax:787-992-7199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15915208D00000X
PR16881207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty