Provider Demographics
NPI:1245711787
Name:COOPERATIVA DE GRUPOS MEDICOS PRIMARIOS IPACOOP
Entity type:Organization
Organization Name:COOPERATIVA DE GRUPOS MEDICOS PRIMARIOS IPACOOP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZAYAS-TORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-625-6120
Mailing Address - Street 1:URB SANTA CRUZ
Mailing Address - Street 2:C8 CALLE 3
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-625-6120
Mailing Address - Fax:787-625-6124
Practice Address - Street 1:URB SANTA CRUZ
Practice Address - Street 2:B7 CALLE SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-625-6120
Practice Address - Fax:787-625-6124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty