# PRESTIGE MEDICAL GROUP LJCPSC

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

## Provider details

- **NPI number:** 1437332624
- **Authorized official:** DR. LORENZO E BOSQUE MD (PRESIDENT)
- **Authorized official phone:** (787) 760-6604

## Contact information

- **Practice address:** MONTEHEIDRA TOWN CTR, GUARAGUAO 145, SAN JUAN, PR 00926-7007
- **Practice address phone:** (787) 760-6604
- **Practice address fax:** (787) 292-0130
- **Mailing address:** MONTEHIEDRA, GUARAGUAO 145, SAN JUAN, PR 00926
- **Mailing address phone:** (787) 760-6604
- **Mailing address fax:** (787) 292-0130

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 4863 | PR | Yes |

## Other

- **Enumeration date:** 12/11/2007
- **Last updated:** 04/03/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4863 | LIC | PR |