Provider Demographics
NPI:1245709823
Name:METRO NORTH MEDICAL GROUP LLC
Entity type:Organization
Organization Name:METRO NORTH MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ITZA
Authorized Official - Middle Name:DORIS
Authorized Official - Last Name:CHEVRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-645-0504
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00954-0867
Mailing Address - Country:US
Mailing Address - Phone:787-473-0888
Mailing Address - Fax:
Practice Address - Street 1:CALLE 1 G12 VILLA MATILDE
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-473-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty