Provider Demographics
NPI:1104216050
Name:PRIMARY MEDICAL GROUP, C.S.P.
Entity type:Organization
Organization Name:PRIMARY MEDICAL GROUP, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRAIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL RIO RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-813-0080
Mailing Address - Street 1:PO BOX 336149
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00733-6149
Mailing Address - Country:US
Mailing Address - Phone:787-813-0080
Mailing Address - Fax:787-840-8874
Practice Address - Street 1:CALLE MENDEZ VIGO #24
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00733
Practice Address - Country:US
Practice Address - Phone:787-842-0005
Practice Address - Fax:787-984-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center