Basic Information
| Provider Information | |||||||||
| NPI: | 1063065159 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS PARTNERS GROUP PUERTO RICO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9725 NW 117TH AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | MEDLEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331781212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545149360 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9725 NW 117TH AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | MEDLEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331781212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877667000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2019 | ||||||||
| LastUpdateDate: | 07/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | QUINTANA | ||||||||
| AuthorizedOfficialFirstName: | RAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | COMPLIANCE | ||||||||
| AuthorizedOfficialTelephone: | 9545149360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.