Basic Information
| Provider Information | |||||||||
| NPI: | 1104034826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRUPO MEDICO DE CAYEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1551 CALLE ALDA | ||||||||
| Address2: | SUITE 201 URB. CARIBE | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009262709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872810810 | ||||||||
| FaxNumber: | 7874743051 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 CALLE ALDA | ||||||||
| Address2: | SUITE 201 URB. CARIBE | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009262709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872810810 | ||||||||
| FaxNumber: | 7874743051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BENGOA | ||||||||
| AuthorizedOfficialFirstName: | ROBERTO | ||||||||
| AuthorizedOfficialMiddleName: | LUIS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7872810810 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305S00000X | Y | Managed Care Organizations | Point of Service |
No ID Information.