Provider Demographics
NPI:1316796980
Name:ESSENTIAL MEDICAL GROUP LLC
Entity type:Organization
Organization Name:ESSENTIAL MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DUENO
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-274-9637
Mailing Address - Street 1:BAYAMON MEDICAL PLAZA 1845 CARR 2 S
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:939-274-9637
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON MEDICAL PLAZA 1845 CARR 2 S
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:939-274-9637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty