Healthcare Provider Details

I. General information

NPI: 1023393733
Provider Name (Legal Business Name): GRUPO MEDICO DEL TOA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CALLE JOSE DE DIEGO
TOA ALTA PR
00954-0000
US

IV. Provider business mailing address

PO BOX 591
TOA ALTA PR
00954-0591
US

V. Phone/Fax

Practice location:
  • Phone: 787-870-2367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: GLADYS NIEVES
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-796-6568