Provider Demographics
NPI:1871883165
Name:GRUPO MEDICO CAROLINA, LLC
Entity type:Organization
Organization Name:GRUPO MEDICO CAROLINA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DIOGENES
Authorized Official - Middle Name:ORESTES
Authorized Official - Last Name:ADAMES ROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-752-1979
Mailing Address - Street 1:PLAZA CAROLINA ST P O BOX 9067
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9067
Mailing Address - Country:US
Mailing Address - Phone:787-752-1979
Mailing Address - Fax:787-276-6299
Practice Address - Street 1:VILLA CAROLINA
Practice Address - Street 2:35-21 CALLE 16
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5440
Practice Address - Country:US
Practice Address - Phone:787-752-1979
Practice Address - Fax:787-276-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRHPSM-0540283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital