Healthcare Provider Details

I. General information

NPI: 1649993635
Provider Name (Legal Business Name): CGCMGT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/23/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE BENTANCES J 23 URB. HERMANAS DAVILAS
BAYAMON PR
00959
US

IV. Provider business mailing address

PO BOX 6350
BAYAMON PR
00960-5350
US

V. Phone/Fax

Practice location:
  • Phone: 787-778-5353
  • Fax: 787-778-5302
Mailing address:
  • Phone: 787-778-5353
  • 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: JOSE J VARGAS
Title or Position: PRESIDENTE
Credential: PRESIDENTE
Phone: 787-778-5353