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General NPI Number Information
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NPI Number | 1033580840
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Entity Type | Organization
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Legal Business Name | BRG MEDICAL LLC
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Dates
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Enumeration Date | 10/20/2015
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 400 AVE DOMENECH STE 607
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City | SAN JUAN
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State | PR
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Zip | 00918-3746
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Country | US
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Telephone | 787-250-0084
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Fax | 787-946-1481
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Provider Business Mailing Address
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Address Line | 400 AVE DOMENECH STE 607
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City | SAN JUAN
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State | PR
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Zip | 00918-3746
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Country | US
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Telephone | 787-250-0084
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Fax | 787-946-1481
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALDEMAR CHARLES RIOS
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Credential | MD
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Telephone | 787-249-4614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 14760
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License Number State | PR
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