Provider Demographics
NPI:1023307915
Name:GCM MEDICAL GROUP, PSC
Entity type:Organization
Organization Name:GCM MEDICAL GROUP, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CORTES MAISONET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-726-8396
Mailing Address - Street 1:PO BOX 13867
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-3867
Mailing Address - Country:US
Mailing Address - Phone:787-726-8396
Mailing Address - Fax:787-919-0640
Practice Address - Street 1:1826 AVE FERNANDEZ JUNCOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-3004
Practice Address - Country:US
Practice Address - Phone:787-726-8396
Practice Address - Fax:787-919-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16033261QR1100X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch