Provider Demographics
NPI:1902125750
Name:ST. RALPHS MEDICAL GROUP
Entity Type:Organization
Organization Name:ST. RALPHS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:NEPTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-863-5050
Mailing Address - Street 1:J1 CALLE PRINCIPAL
Mailing Address - Street 2:URB BARALT
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3771
Mailing Address - Country:US
Mailing Address - Phone:787-863-5050
Mailing Address - Fax:787-860-5050
Practice Address - Street 1:J1 CALLE PRINCIPAL
Practice Address - Street 2:URB BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3771
Practice Address - Country:US
Practice Address - Phone:787-863-5050
Practice Address - Fax:787-860-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4853261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0026029Medicare PIN