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General NPI Number Information
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NPI Number | 1376868380
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Entity Type | Organization
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Legal Business Name | RIO GRANDE MEDICAL GROUP
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | VILLAS DE RIO GRANDE CALLE 4 L 1
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City | RIO GRANDE
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State | PR
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Zip | 00745-0000
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Country | US
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Telephone | 787-888-7336
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Fax | 787-887-4045
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Provider Business Mailing Address
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Address Line | VILLAS DE RIO GRANDE CALLE 4 L 1
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City | RIO GRANDE
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State | PR
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Zip | 00745-0000
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Country | US
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Telephone | 787-888-7336
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Fax | 787-887-4045
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARMEN LOPEZ
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Credential | M.D.
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Telephone | 787-637-4449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number | 172590
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License Number State | PR
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