Healthcare Provider Details

I. General information

NPI: 1891773347
Provider Name (Legal Business Name): ESG GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALLE BARCELO SUITE 217 PLAZA SAN CRISTOBAL
BARRANQUITAS PR
00794-1709
US

IV. Provider business mailing address

3 CALLE BARCELO STE 217 PLAZA SAN CRISTOBAL
BARRANQUITAS PR
00794-1709
US

V. Phone/Fax

Practice location:
  • Phone: 787-857-7777
  • Fax: 787-857-3792
Mailing address:
  • Phone: 787-857-7777
  • Fax: 787-857-3792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number806
License Number StatePR

VIII. Authorized Official

Name: EUGENIO RIVERA RIOS
Title or Position: DIRECTOR
Credential:
Phone: 787-374-5715