Healthcare Provider Details

I. General information

NPI: 1861116816
Provider Name (Legal Business Name): INTERNATIONAL MEDICAL GROUP INTERMDGROUP S.R.L.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOULEVARD TURISTICO DEL ESTE, ESQ. COCOTAL
BAVARO PUNTA CANA
23000
DO

IV. Provider business mailing address

PO BOX 39192
FORT LAUDERDALE FL
33339-9192
US

V. Phone/Fax

Practice location:
  • Phone: 809-285-6116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: CARLOS A PRATO ZULUAGA
Title or Position: CEO
Credential:
Phone: 954-526-9751