Provider Demographics
NPI:1336352483
Name:ISLAND MEDICAL GROUP
Entity Type:Organization
Organization Name:ISLAND MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCILIO
Authorized Official - Middle Name:ALVARADO
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-306-8356
Mailing Address - Street 1:PO BOX 194000
Mailing Address - Street 2:PMB 279
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919
Mailing Address - Country:US
Mailing Address - Phone:787-279-7512
Mailing Address - Fax:787-279-7512
Practice Address - Street 1:AVENIDA LA CONSTITUCION #530
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00901
Practice Address - Country:US
Practice Address - Phone:787-279-7512
Practice Address - Fax:787-279-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32CNC04-328PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center