1710789110 NPI number — PRIMARY CARE PHYSICIAN FOR ALL LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710789110 NPI number — PRIMARY CARE PHYSICIAN FOR ALL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY CARE PHYSICIAN FOR ALL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710789110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
D-22 CALLE REGENCIA
Provider Second Line Business Mailing Address:
URB PASEO REAL
Provider Business Mailing Address City Name:
COAMO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-319-8826
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 CALLE WILLIE ROSARIO
Provider Second Line Business Practice Location Address:
BAJOS
Provider Business Practice Location Address City Name:
COAMO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-631-7905
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2025

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES-RODRIGUEZ
Authorized Official First Name:
JAVIER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-319-8826

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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