Organization
PUERTO RICO PERFORMANCE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCIENNE LAUREANO (PRESIDENT)
(787) 460-0538
Entity
Organization
Contact information
Practice address
1 F12 PRADO ALTO, GUAYNABO, PR 00966
(787) 460-1129
Mailing address
F12 CALLE 1, GUAYNABO, PR 00966-3022
(787) 460-1129
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
219
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
305500000X
MANAGE CARE ORGANIZATION
PR
Enumeration date
10/22/2013
Last updated
09/29/2021
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