Provider Demographics
NPI:1104951623
Name:GRUPO MEDICO LA AMISTAD, INC.
Entity type:Organization
Organization Name:GRUPO MEDICO LA AMISTAD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GRETZA
Authorized Official - Middle Name:O
Authorized Official - Last Name:CASTRO CURET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-740-4240
Mailing Address - Street 1:HC-01 BOX 8017
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-740-4240
Mailing Address - Fax:787-740-4240
Practice Address - Street 1:CARR. 863 KM 2.0 BARRIO PAJAROS, SECTOR TRES CALLES
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-740-4240
Practice Address - Fax:787-740-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14,276208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty