Provider Demographics
NPI:1720256191
Name:WESTEN PRIMARY GROUP CSP
Entity Type:Organization
Organization Name:WESTEN PRIMARY GROUP CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-890-2000
Mailing Address - Street 1:PMB 231
Mailing Address - Street 2:PO BOX 605703
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:787-890-2000
Mailing Address - Fax:
Practice Address - Street 1:PMB 231
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-890-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization