Healthcare Provider Details

I. General information

NPI: 1346414679
Provider Name (Legal Business Name): GRUPO RESCUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR BAVARO, EDIFRICIO CENTRO MEDICO PUNTA CANA E/ FRIUSA Y PLAZA BAVARO
BAVARO LA ALTAGRACIA
23000
DO

IV. Provider business mailing address

3508 NW 114 AVE BM 30095, PMB
DORAL FL
33178
US

V. Phone/Fax

Practice location:
  • Phone: 809-552-1506
  • Fax: 809-552-1974
Mailing address:
  • Phone: 305-235-9920
  • Fax: 305-675-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BORIS NIKOLOV
Title or Position: CLAIMS MANAGER
Credential: MD
Phone: 305-235-9920