Healthcare Provider Details

I. General information

NPI: 1659553931
Provider Name (Legal Business Name): TMG MEDICAL GROUP CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE TOMAS DAVILA #1
BARCELONETA PR
00617
US

IV. Provider business mailing address

PO BOX 359
BARCELONETA PR
00617-0359
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-6890
  • Fax: 787-846-5458
Mailing address:
  • Phone: 787-846-6890
  • Fax: 787-846-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. WALDEMAR R RIVERA
Title or Position: MED
Credential:
Phone: 787-846-6890