# NORTH SHORE MEDICAL GROUP LLC

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

## Provider details

- **NPI number:** 1801334883
- **Authorized official:** DR. ANA M RODRIGUEZ - PORTELA MD (PRESIDENT)
- **Authorized official phone:** (787) 345-9682

## Contact information

- **Practice address:** 39 CARR 2, HOSPITAL WILMA N VAZQUEZ SUITE 101, VEGA BAJA, PR 00693-4824
- **Practice address phone:** (787) 858-3550
- **Practice address fax:** (787) 855-3339
- **Mailing address:** 781 CALLE ARRAYADO, URB. SAN DEMETRIO, VEGA BAJA, PR 00693
- **Mailing address phone:** (787) 858-3550
- **Mailing address fax:** (787) 855-3339

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 16634 | PR | Yes |
| 208D00000X | General Practice Physician | 14001 | PR | — |

## Other

- **Enumeration date:** 02/09/2017
- **Last updated:** 02/09/2017