Healthcare Provider Details

I. General information

NPI: 1780940924
Provider Name (Legal Business Name): PR HEALTHCARE MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B13 CALLE B URB LAS VILLAS TOWNHOUSES
GUAYNABO PR
00969-3261
US

IV. Provider business mailing address

B13 CALLE B URB LAS VILLAS TOWNHOUSES
GUAYNABO PR
00969-3261
US

V. Phone/Fax

Practice location:
  • Phone: 787-637-6274
  • Fax: 787-874-3125
Mailing address:
  • Phone: 787-637-6274
  • Fax: 787-874-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY E NEGRON
Title or Position: PRINCIPAL
Credential: MD
Phone: 787-637-6274