# GRUPO MEDICO DEL NORTE INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MIRAMAR MEDICAL CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730550393
- **Authorized official:** DR. IVAN CEREZO M.D. (PRESIDENT)
- **Authorized official phone:** (787) 721-5696

## Contact information

- **Practice address:** 804 AVE PONCE DE LEON, SUITE 101A, SAN JUAN, PR 00907-3301
- **Practice address phone:** (787) 721-5696
- **Mailing address:** 804 AVE PONCE DE LEON, SUITE 101A, SAN JUAN, PR 00907-3301
- **Mailing address phone:** (787) 721-5696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 352173 | PR | Yes |

## Other

- **Enumeration date:** 10/08/2015
- **Last updated:** 10/08/2015