Healthcare Provider Details

I. General information

NPI: 1558818484
Provider Name (Legal Business Name): PR HEALTHCARE MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2016
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 31 KM. 4.0
NAGUABO PR
00718
US

IV. Provider business mailing address

PO BOX 2598
GUAYNABO PR
00970-2598
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number57686
License Number StatePR

VIII. Authorized Official

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