Provider Demographics
NPI:1447651534
Name:GRUPO DE MEDICINA FAMILIAR DE COROZAL, INC.
Entity type:Organization
Organization Name:GRUPO DE MEDICINA FAMILIAR DE COROZAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORTIZ CALDERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-859-6452
Mailing Address - Street 1:PO BOX 94000
Mailing Address - Street 2:PMB 108
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-859-6452
Mailing Address - Fax:787-859-6452
Practice Address - Street 1:#23 CALLE LAS MERCEDES
Practice Address - Street 2:
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-6452
Practice Address - Fax:787-859-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRGMP356Medicaid