Provider Demographics
NPI:1962133702
Name:FIVE STARS MEDICAL GROUP LLC
Entity type:Organization
Organization Name:FIVE STARS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ-DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-704-9897
Mailing Address - Street 1:352 CALLE SAN CLAUDIO STE 164
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4143
Mailing Address - Country:US
Mailing Address - Phone:787-292-2770
Mailing Address - Fax:
Practice Address - Street 1:200 CALLE CUPEY GDNS STE 8W
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7373
Practice Address - Country:US
Practice Address - Phone:787-292-2770
Practice Address - Fax:787-292-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty