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Organization

MD RENAL GROUP LLC

Active
Other names
MD Renal Group LLC
Organization subpart
No

Provider details

NPI number
Authorized official
PROF. MAYRA I SANTIAGO M.A. (ADMINISTRATIVE CHIEF OFFICER)
(939) 639-0557
Entity
Organization

Contact information

Practice address
AVENUE SEVERIANO CUEVAS 18, HOSPITAL BUEN SAMARITANO GROUND FLOOR, AGUADILLA, PR 00605-9026
(787) 997-0101
Mailing address
PO BOX 667, MOCA, PR 00676-0667
(787) 997-0101

Taxonomy

Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
17129
PR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1043595291
NPI
PR
Enumeration date
10/19/2011
Last updated
08/14/2012
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