Grupo Medico del Norte Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

352173 Issued in PR

Legal business name

GRUPO MEDICO DEL NORTE INC.

Doing business as

Miramar Medical Clinic

Practice address

804 Ave Ponce de Leon
Suite 101a
San Juan, PR 00907-3301

Phone

(787) 721-5696

NPI assigned

Oct 8, 2015

Last updated

Oct 8, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ivan Cerezo, M.D.

Title

President

Phone

(787) 721-5696

Specialties & licenses 1

Addresses

Other names 1

• MIRAMAR MEDICAL CLINIC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444262400000",
    "number": "1730550393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 AVE PONCE DE LEON",
            "address_2": "SUITE 101A",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009073301",
            "telephone_number": "787-721-5696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 AVE PONCE DE LEON",
            "address_2": "SUITE 101A",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009073301",
            "telephone_number": "787-721-5696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRUPO MEDICO DEL NORTE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-08",
        "last_updated": "2015-10-08",
        "status": "A",
        "authorized_official_last_name": "CEREZO",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-721-5696",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "PR",
            "license": "352173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MIRAMAR MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in San Juan, PR
• Providers in San Juan, PR by specialty
• Clinic/Center in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.