Healthcare Provider Details

I. General information

NPI: 1215459813
Provider Name (Legal Business Name): PR HEALTHCARE MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 31 KM 4.0 NAGUABO MEDICAL MALL
NAGUABO PR
00718
US

IV. Provider business mailing address

PO BOX 2598
GUAYNABO PR
00970-2598
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY EMILIO NEGRON JUDICE
Title or Position: PRESIDENT
Credential: MD
Phone: 787-637-6274