Provider Demographics
NPI:1487990545
Name:PGA CONSULTING GROUP
Entity type:Organization
Organization Name:PGA CONSULTING GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:TAPIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-636-6189
Mailing Address - Street 1:RR 6 BOX 11167
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-636-6189
Mailing Address - Fax:
Practice Address - Street 1:13 CAMINO LOS BAEZ APT 802
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-9636
Practice Address - Country:US
Practice Address - Phone:787-636-6189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GT MEDICAL DIABETES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment