Provider Demographics
NPI:1295732535
Name:GRUPO GERIATRICO DE MEDICINA DE FAMILIA, INC.
Entity type:Organization
Organization Name:GRUPO GERIATRICO DE MEDICINA DE FAMILIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-787-9694
Mailing Address - Street 1:IJ-3 CALLE PALMA REAL P2
Mailing Address - Street 2:URB ROYAL PALM
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-787-9694
Mailing Address - Fax:787-787-9701
Practice Address - Street 1:IJ-3 CALLE PALMA REAL P2
Practice Address - Street 2:URB ROYAL PALM
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-9694
Practice Address - Fax:787-787-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8723174400000X
PR9865174400000X
PR7119174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100293OtherLA CRUZ AZUL DE PR
PR890448OtherMMM HEALTHCARE
PR3120OtherPREFERRED MEDICAL CHOICE
PR890448OtherMMM HEALTHCARE
PR890448OtherMMM HEALTHCARE