Provider Demographics
NPI:1366432783
Name:GRUPO DE SERVICIOS GERIATRICO
Entity type:Organization
Organization Name:GRUPO DE SERVICIOS GERIATRICO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:MILAGROS
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:787-761-1943
Mailing Address - Street 1:488 CARR 845
Mailing Address - Street 2:URB PURPLE TREE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4403
Mailing Address - Country:US
Mailing Address - Phone:787-761-1945
Mailing Address - Fax:787-761-1947
Practice Address - Street 1:488 CARR 845
Practice Address - Street 2:URB PURPLE TREE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4403
Practice Address - Country:US
Practice Address - Phone:787-761-1945
Practice Address - Fax:787-761-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9548207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9280057OtherHUMANA HEALTH PLANS
PR2758OtherPREFERRED MEDICARE CHOICE
PR500168EOtherMEDICARE Y MUCHO MAS MMM
PR81953OtherMEDICARE OPTIMO
PR069435OtherCRUZ AZUL
PR20085OtherPREFERRED HEALTH (UTI)
PR4214OtherINTERNATIONAL MEDICAL CAR
PR81953OtherTRIPLE S
PR9280057OtherHUMANA INSURANCE OF PR
PR069435OtherCRUZ AZUL
PR2758OtherPREFERRED MEDICARE CHOICE