Provider Demographics
NPI:1366766826
Name:SKY MEDICAL GROUP & RESOURCES CSP
Entity type:Organization
Organization Name:SKY MEDICAL GROUP & RESOURCES CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADORA
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-370-8994
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0819
Mailing Address - Country:US
Mailing Address - Phone:787-897-7877
Mailing Address - Fax:
Practice Address - Street 1:129 STREET 24.8KM
Practice Address - Street 2:BO CALLEJONES
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-0819
Practice Address - Country:US
Practice Address - Phone:787-897-7877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QH0100X261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR021261OtherLICENSE NUMBER
PR021261OtherLICENSE NUMBER