# GRUPO MEDICO IPA 555

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235346438
- **Authorized official:** DR. RAFAEL LUZARDO M.D. (ADMINISTRATOR)
- **Authorized official phone:** (787) 721-0279

## Contact information

- **Practice address:** CALLE SAN FRANCISCO 405, SUITE 2-C, SAN JUAN, PR 00902
- **Practice address phone:** (787) 721-0279
- **Practice address fax:** (787) 721-0279
- **Mailing address:** PO BOX 9023558, SAN JUAN, PR 00902-3558

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 05/17/2007
- **Last updated:** 08/22/2020