Provider Demographics
NPI:1124252101
Name:PAMG INDEPENDENT PRACTICE NETWORK CORP.
Entity type:Organization
Organization Name:PAMG INDEPENDENT PRACTICE NETWORK CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:GONZALEZ BERDECIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-813-2324
Mailing Address - Street 1:PMB 282 1575 MUNOZ RIVERA AVE.
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717
Mailing Address - Country:US
Mailing Address - Phone:787-813-2324
Mailing Address - Fax:787-841-3908
Practice Address - Street 1:1266 AVE. HOSTOS ESQ. POWER
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-813-2324
Practice Address - Fax:787-841-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization