Provider Demographics
NPI:1750956801
Name:COHESIVELY MEDICAL GROUP LLC
Entity type:Organization
Organization Name:COHESIVELY MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSUE
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:787-674-0183
Mailing Address - Street 1:PO BOX 195615
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5615
Mailing Address - Country:US
Mailing Address - Phone:787-523-5767
Mailing Address - Fax:800-920-7754
Practice Address - Street 1:36 CORPORATE OFFICE PARK, PR-20, SUITE 301
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-523-5767
Practice Address - Fax:800-972-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty