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NPI Code Detail

MEDICARE: CASSIOPEIA MANAGEMENT GROUP LLC

MEDICARE: CASSIOPEIA MANAGEMENT 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
1261QP2300XPrimary Care Clinic/Center
2251B00000XCase Management Agency

General Provider Information

NPI Number : 1619471299
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASSIOPEIA MANAGEMENT GROUP LLC
Provider Business Mailing Address
First Line : PASEO LAS OLAS
Second Line : 341 CALLE TIBURON
City : DORADO
State : PR
Zip : 00646-4653
Country : US
Telephone Number : 787-692-8698
Fax Number :
Provider Business Practice Location Address
First Line : PASEO LAS OLAS
Second Line : Q4 CALLE TIBURON
City : DORADO
State : PR
Zip : 00646-4653
Country : US
Telephone Number : 787-692-8698
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : ARTURO LUIS ORTIZ ECHEVARRIA
Credential :
Telephone Number : 787-692-8698
Provider Enumeration Date : 03/20/2018
Last Update Date : 03/20/2018

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Directions to “CASSIOPEIA MANAGEMENT GROUP LLC ” Practice Location

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