Healthcare Provider Details

I. General information

NPI: 1083131288
Provider Name (Legal Business Name): MEDICAL EDUCATION GROUP PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HILLSIDE VILLAGE APT CARACOLES C202
RIO GRANDE PR
00745
US

IV. Provider business mailing address

HILLSIDE VILLAGE APT CARACOLES C202
RIO GRANDE PR
00745
US

V. Phone/Fax

Practice location:
  • Phone: 787-233-2757
  • Fax:
Mailing address:
  • Phone: 787-233-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ORVILL RAMOS DIAZ
Title or Position: PRESIDENT
Credential: MD
Phone: 787-233-2757