MEDICARE: GRUPO OTORRINOLARINGOLOGICO DE PR CSP

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	12188	PR
2	2085N0700X	Neuroradiology Physician
3	231H00000X	Audiologist
4	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	11711	PR

General Provider Information

NPI Number	:	1396772539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRUPO OTORRINOLARINGOLOGICO DE PR CSP

Provider Business Mailing Address
First Line	:	BAYAMON MEDICAL PLAZA 1845 CARRETERA 2
Second Line	:	SUITE 105
City	:	BAYAMON
State	:	PR
Zip	:	00959-7203
Country	:	US
Telephone Number	:	787-785-8981
Fax Number	:	787-776-1511

Provider Business Practice Location Address
First Line	:	1845 CARR 2 STE 105
Second Line	:	BAYAMON MEDICAL PLAZA
City	:	BAYAMON
State	:	PR
Zip	:	00959-7203
Country	:	US
Telephone Number	:	787-785-8981
Fax Number	:	787-776-1511

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSE R SANCHEZ SR.
Credential	:	MD
Telephone Number	:	787-785-8981

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	12/01/2014

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Directions to “GRUPO OTORRINOLARINGOLOGICO DE PR CSP ” Practice Location

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