=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265058846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLATINUM GROUP PRIMARY CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2020
-----------------------------------------------------
Last Update Date | 04/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 CALLE BLANCO SOSA
-----------------------------------------------------
City | VEGA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00693-4475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-858-7676
-----------------------------------------------------
Fax | 787-858-0840
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4144
-----------------------------------------------------
City | VEGA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00694-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-858-7676
-----------------------------------------------------
Fax | 787-858-0840
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALFREDO RODRIGUEZ SANCHEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 787-858-3775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------