Provider Demographics
NPI:1750575221
Name:NGC MEDICAL SERVICE
Entity type:Organization
Organization Name:NGC MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NIDZA
Authorized Official - Middle Name:GOMEZ
Authorized Official - Last Name:COLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-724-6590
Mailing Address - Street 1:CALLE SAN RAFAEL 1396 MEDICAL PAVILLION
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910
Mailing Address - Country:US
Mailing Address - Phone:787-603-3660
Mailing Address - Fax:787-724-7280
Practice Address - Street 1:CALLE SAN RAFAEL 1396 MEDICAL PAVILLION
Practice Address - Street 2:SUITE 11
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910
Practice Address - Country:US
Practice Address - Phone:787-603-3660
Practice Address - Fax:787-724-7280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6232261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC84227Medicare UPIN