Provider Demographics
NPI:1750907390
Name:GRUPO INTEGRADO MEDICINA PRIMARIA INC
Entity type:Organization
Organization Name:GRUPO INTEGRADO MEDICINA PRIMARIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BILLING & COLLECTION
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-434-1700
Mailing Address - Street 1:PO BOX 1650
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1650
Mailing Address - Country:US
Mailing Address - Phone:787-434-1700
Mailing Address - Fax:787-434-1715
Practice Address - Street 1:CARRETERA 778 KM. 9
Practice Address - Street 2:BO PASARELL PUEBLO
Practice Address - City:COMERO
Practice Address - State:PR
Practice Address - Zip Code:00782-8888
Practice Address - Country:US
Practice Address - Phone:787-434-1700
Practice Address - Fax:787-434-1715
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRUPO INTEGRADO MEDICINA PRIMARIA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty