Basic Information
| Provider Information | |||||||||
| NPI: | 1407125255 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GRUPO MEDICO SAMARITANO PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | URB CIUDAD JARDIN | ||||||||
| Address2: | 51 CALLE SIEMPREVIVA | ||||||||
| City: | GURABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007780000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872101439 | ||||||||
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| Practice Location | |||||||||
| Address1: | BARRIO BARRAZAS CARRETERA 182 KM 3 | ||||||||
| Address2: | |||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009810000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876611070 | ||||||||
| FaxNumber: | 7877610613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2011 | ||||||||
| LastUpdateDate: | 12/23/2011 | ||||||||
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| AuthorizedOfficialLastName: | DELGADO AGOSTO | ||||||||
| AuthorizedOfficialFirstName: | IRIS | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENTA | ||||||||
| AuthorizedOfficialTelephone: | 7872101439 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | PR | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PE0004X | PR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
No ID Information.