Provider Demographics
NPI:1871169219
Name:WGM HEALTH SERVICES LLC
Entity type:Organization
Organization Name:WGM HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-995-0884
Mailing Address - Street 1:3197 CALLE RIO GUAYABO
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9120
Mailing Address - Country:US
Mailing Address - Phone:787-667-9943
Mailing Address - Fax:
Practice Address - Street 1:CARR 831 KM 4 7 MINILLAS
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-9998
Practice Address - Country:US
Practice Address - Phone:787-995-0884
Practice Address - Fax:939-336-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038623400Medicaid