Organization
PR PROFESSIONAL MEDICAL GROUP, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUITXA BAEZ MD (TESORERA)
(787) 205-2114
Entity
Organization
Contact information
Practice address
AVE. DEGETAU SEGUNDA EXTENSION ESQUINA EL VERDE, CALLE I #2A, CAGUAS, PR 00725-0000
(787) 205-2114
Mailing address
PMB 071, PO BOX 4952, CAGUAS, PR 00726-0000
(787) 205-2114
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6227
REGISTER NUMBER
PR
Enumeration date
11/12/2010
Last updated
03/01/2011
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