Healthcare Provider Details

I. General information

NPI: 1174593545
Provider Name (Legal Business Name): PRIMARY MEDICAL GROUP,C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FERROCARRIL # 607
PONCE PR
00717-1195
US

IV. Provider business mailing address

PO BOX 336149
PONCE PR
00733-6149
US

V. Phone/Fax

Practice location:
  • Phone: 787-813-0257
  • Fax: 787-840-8874
Mailing address:
  • Phone: 787-813-0257
  • Fax: 787-840-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: IRAIDA DEL RIO
Title or Position: PRESIDENTE
Credential: M.D.
Phone: 787-813-0080