Healthcare Provider Details

I. General information

NPI: 1164669156
Provider Name (Legal Business Name): PLATINUM EMERGENCY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 853 KM 11.7 BO BARRAZAS
CAROLINA PR
00979
US

IV. Provider business mailing address

130 AVE WINSTON CHURCHILL PMB 364 SUITE 1
SAN JUAN PR
00926-6018
US

V. Phone/Fax

Practice location:
  • Phone: 787-616-0032
  • Fax:
Mailing address:
  • Phone: 787-616-0032
  • Fax: 787-822-6298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. JOSE M NEGRON
Title or Position: VP
Credential: M.D.
Phone: 787-548-5380