Provider Demographics
NPI:1538925284
Name:MSO OF PUERTO RICO
Entity type:Organization
Organization Name:MSO OF PUERTO RICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA PESANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-622-3000
Mailing Address - Street 1:350 CHARDON AVE
Mailing Address - Street 2:TORRE CHARDON SUITE 600
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-622-3000
Mailing Address - Fax:
Practice Address - Street 1:350 CHARDON AVE
Practice Address - Street 2:TORRE CHARDON SUITE 600
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-622-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty