Provider Demographics
NPI:1740326677
Name:GRUPO OTORRINOLARINGOLOGICO DE PR
Entity type:Organization
Organization Name:GRUPO OTORRINOLARINGOLOGICO DE PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANCHEZ MENDIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-785-8981
Mailing Address - Street 1:BAYAMON MEDICAL PLAZA
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-785-8981
Mailing Address - Fax:787-780-4866
Practice Address - Street 1:PLAZA CAROLINA MALL
Practice Address - Street 2:SUITE 11
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-776-1511
Practice Address - Fax:787-776-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty