Healthcare Provider Details

I. General information

NPI: 1558682849
Provider Name (Legal Business Name): RGD MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CALLE GUAYAMA
SAN JUAN PR
00917-4512
US

IV. Provider business mailing address

109 CALLE GUAYAMA
SAN JUAN PR
00917-4512
US

V. Phone/Fax

Practice location:
  • Phone: 787-989-5593
  • Fax:
Mailing address:
  • Phone: 787-989-5593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number17940
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number17940
License Number StatePR

VIII. Authorized Official

Name: DR. ALEX DANIEL ANDUJAR
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 787-989-5593