Provider Demographics
NPI:1447884564
Name:EDUCA GROUP
Entity type:Organization
Organization Name:EDUCA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-453-8855
Mailing Address - Street 1:5689 CALLE PARQUE
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-9830
Mailing Address - Country:US
Mailing Address - Phone:787-453-8855
Mailing Address - Fax:
Practice Address - Street 1:CDT JAYUYA
Practice Address - Street 2:2 CALLE ROSANTA AULET
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:787-453-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDUCA GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6115Medicaid