Provider Demographics
NPI:1841454998
Name:UNIVERSAL & PROFESIONAL MEDICAL GROUP
Entity type:Organization
Organization Name:UNIVERSAL & PROFESIONAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATACHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMOZA
Authorized Official - Suffix:
Authorized Official - Credentials:TERAPEUTA DEL MASAJE
Authorized Official - Phone:787-403-0237
Mailing Address - Street 1:24-63 AVENUE: ROBERTO CLEMENTE
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-403-0237
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPP CTR
Practice Address - Street 2:24-63 AVENUE:ROBERTO CLEMENTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5672
Practice Address - Country:US
Practice Address - Phone:787-403-0237
Practice Address - Fax:787-946-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR246W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, CardiologyGroup - Multi-Specialty