| Organization Name: | PUERTO RICO MEDICAL GROUP |
| NPI Number: | 1043512197 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAFAEL R LUZARDO (PRESIDENT) |
| Mailing Address: | 405 Calle San Francisco Piso 2 Oficina 2-c San Juan |
| State: | PR US |
| Postal Code: | 009011772 |
| Phone Number: | 7877254548 |
| Fax Number: | 7877210279 |
| NPI Enumeration Date: | 11/23/2010 |
| NPI Last Update Date: | 11/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |