Provider Demographics
NPI:1033580840
Name:BRG MEDICAL LLC
Entity type:Organization
Organization Name:BRG MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALDEMAR
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-249-4614
Mailing Address - Street 1:400 AVE DOMENECH STE 607
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3746
Mailing Address - Country:US
Mailing Address - Phone:787-250-0084
Mailing Address - Fax:787-946-1481
Practice Address - Street 1:400 AVE DOMENECH STE 607
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3746
Practice Address - Country:US
Practice Address - Phone:787-250-0084
Practice Address - Fax:787-946-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty