| Organization Name: | LARES MEDICAL GROUP |
| NPI Number: | 1134284425 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RODRIGUEZ BALTAZAR (DIRECTOR) |
| Mailing Address: | Carr 111 Km 2.9 Ave. Los Patriotas Lares |
| State: | PR US |
| Postal Code: | 006691427 |
| Phone Number: | 7878971444 |
| Fax Number: | 7878974952 |
| NPI Enumeration Date: | 12/27/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | ========= |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |