| Jose Lares-guia Physician Pc | |
|
84 Grove St Apt 3 New York NY 10014-3566 | |
| (646) 429-5555 | |
| (678) 553-1274 |
| Full Name | Jose Lares-guia Physician Pc |
|---|---|
| Speciality | General Practice |
| Location | 84 Grove St Apt 3, New York, New York |
| Authorized Official Name and Position | Jose M Lares-guia (SOLE PROPRIETOR) |
| Authorized Official Contact | 9176136030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jose Lares-guia Physician Pc 84 Grove St Apt 3 New York NY 10014-3566 Ph: (646) 429-9555 | Jose Lares-guia Physician Pc 84 Grove St Apt 3 New York NY 10014-3566 Ph: (646) 429-5555 |
| NPI Number | 1760816367 |
|---|---|
| Provider Enumeration Date | 08/30/2013 |
| Last Update Date | 03/16/2024 |
| Medicare PECOS PAC ID | 8628203288 |
|---|---|
| Medicare Enrollment ID | O20131107000150 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760816367 | NPI | - | NPPES |
| 03161662 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Jose Miguel Lares-guia |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1902030869 PECOS PAC ID: 4486788460 Enrollment ID: I20100812000404 |
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