Provider Demographics
NPI:1063969186
Name:ONE MEDICAL GROUP CORPORATION
Entity type:Organization
Organization Name:ONE MEDICAL GROUP CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-892-8092
Mailing Address - Street 1:102 CALLE DR VEVE
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4132
Mailing Address - Country:US
Mailing Address - Phone:787-892-8092
Mailing Address - Fax:888-777-9122
Practice Address - Street 1:102 CALLE DR VEVE
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4132
Practice Address - Country:US
Practice Address - Phone:787-892-8092
Practice Address - Fax:888-777-9122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization