MEDICARE: PUERTO RICO PULMONARY GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1023950961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUERTO RICO PULMONARY GROUP LLC

Provider Business Mailing Address
First Line	:	KK-7 VIA PERIFERICA
Second Line	:	URB. JARDINES DE CAPARRA
City	:	BATAMON
State	:	PR
Zip	:	00959-7628
Country	:	US
Telephone Number	:	787-597-5945
Fax Number	:	787-269-3900

Provider Business Practice Location Address
First Line	:	73 EDIFICIO SANTA CRUZ STE313
Second Line	:	CALLE SANTA CRUZ
City	:	BAYAMON
State	:	PR
Zip	:	00956
Country	:	US
Telephone Number	:	787-930-4845
Fax Number	:	787-537-7071

Authorized Official
Title or Position	:	OWNER
Name	:	GRACIELA LATALLADI ORTEGA
Credential	:	M.D.
Telephone Number	:	787-930-4845

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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