Provider Demographics
NPI:1215212469
Name:JMMC MEDICAL GROUP, CP
Entity type:Organization
Organization Name:JMMC MEDICAL GROUP, CP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICEPRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:CASTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-604-7776
Mailing Address - Street 1:2M8 AVE. LAUREL PMB 202
Mailing Address - Street 2:URB. LOMAS VERDES
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2U5 AVE. LAUREL LOCAL 1
Practice Address - Street 2:URB. LOMAS VERDES
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-604-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14334261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care