Basic Information
| Provider Information | |||||||||
| NPI: | 1285980052 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLATINUM EMERGENCY PHYSICIANS, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 AVE WINSTON CHURCHILL | ||||||||
| Address2: | PMB 359, SUITE 1 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009266018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873667726 | ||||||||
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| Practice Location | |||||||||
| Address1: | CARR 129 KM 0.1 | ||||||||
| Address2: | AVE SAN LUIS | ||||||||
| City: | ARECIBO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876507275 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2012 | ||||||||
| LastUpdateDate: | 07/31/2012 | ||||||||
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| AuthorizedOfficialLastName: | MEJIA | ||||||||
| AuthorizedOfficialFirstName: | JORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7873667726 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 13958 | PR | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.