Provider Demographics
NPI:1063065159
Name:PHYSICIANS PARTNERS GROUP PUERTO RICO LLC
Entity type:Organization
Organization Name:PHYSICIANS PARTNERS GROUP PUERTO RICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-514-9360
Mailing Address - Street 1:9725 NW 117TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1212
Mailing Address - Country:US
Mailing Address - Phone:954-514-9360
Mailing Address - Fax:
Practice Address - Street 1:9725 NW 117TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1212
Practice Address - Country:US
Practice Address - Phone:787-766-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care