Healthcare Provider Details

I. General information

NPI: 1104128560
Provider Name (Legal Business Name): NORTH BORINQUEN MEDICAL GROUP,CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE GENERAL DEL VALLE # 1007 RIO PIEDRAS
SAN JUAN PR
00924
US

IV. Provider business mailing address

CALLE GENERAL DEL VALLE # 999 APARTADO 100 RIO PIEDRAS
SAN JUAN PR
00924
US

V. Phone/Fax

Practice location:
  • Phone: 939-258-5800
  • Fax: 939-258-5800
Mailing address:
  • Phone: 939-258-5800
  • Fax: 939-258-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAFAEL CRESPO
Title or Position: PRESIDENTE
Credential: M.D.
Phone: 787-617-4156