Provider Demographics
NPI:1396772539
Name:GRUPO OTORRINOLARINGOLOGICO DE PR CSP
Entity type:Organization
Organization Name:GRUPO OTORRINOLARINGOLOGICO DE PR CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:787-785-8981
Mailing Address - Street 1:BAYAMON MEDICAL PLAZA 1845 CARRETERA 2
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7203
Mailing Address - Country:US
Mailing Address - Phone:787-785-8981
Mailing Address - Fax:787-776-1511
Practice Address - Street 1:1845 CARR 2 STE 105
Practice Address - Street 2:BAYAMON MEDICAL PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7203
Practice Address - Country:US
Practice Address - Phone:787-785-8981
Practice Address - Fax:787-776-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12188207YX0905X
2085N0700X, 231H00000X
PR11711207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0089339Medicare ID - Type Unspecified
0089338Medicare ID - Type Unspecified