Healthcare Provider Details

I. General information

NPI: 1356678569
Provider Name (Legal Business Name): COMPREHENSIVE STAR MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BAYAMON MEDICAL MALL AVENIDA BETANCES J-23
BAYAMON PR
00959-7200
US

IV. Provider business mailing address

BAYAMON MEDICAL MALL AVENIDA BETANCES J-23
BAYAMON PR
00959-7200
US

V. Phone/Fax

Practice location:
  • Phone: 787-778-5311
  • Fax: 787-778-5302
Mailing address:
  • Phone: 787-778-5311
  • Fax: 787-778-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE VARGAS
Title or Position: PRESIDENT
Credential:
Phone: 787-778-5311