Provider Demographics
NPI:1134948722
Name:P G OF M S.A. DE C.V.
Entity type:Organization
Organization Name:P G OF M S.A. DE C.V.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEFERINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-526-9751
Mailing Address - Street 1:PO BOX 11661
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LA BEGONA MZ 23 LT 11 COL MONTERREAL RSDAL
Practice Address - Street 2:
Practice Address - City:SAN JOSE DEL CABO
Practice Address - State:BAJA CALIFORNIA SUR
Practice Address - Zip Code:23444
Practice Address - Country:MX
Practice Address - Phone:624-211-8570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management