Provider Demographics
NPI:1740615640
Name:PUERTO RICO RENAL CONSULTING AND RESEARCH GROUP, INC.
Entity type:Organization
Organization Name:PUERTO RICO RENAL CONSULTING AND RESEARCH GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-644-9253
Mailing Address - Street 1:512 A JUAN J. JIMENEZ
Mailing Address - Street 2:
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-886-3254
Mailing Address - Fax:787-957-1555
Practice Address - Street 1:512 A JUAN J. JIMENEZ ST.
Practice Address - Street 2:
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-886-3254
Practice Address - Fax:787-957-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty