1205239589 NPI number — FAMILY HEALTH CLINIC OF CARIBBEAN, INC

Table of content: (NPI 1205239589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205239589 NPI number — FAMILY HEALTH CLINIC OF CARIBBEAN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CLINIC OF CARIBBEAN, INC
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:
1205239589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 867
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOA ALTA
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00954
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
787-870-7852
Provider Business Mailing Address Fax Number:
787-870-7852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
G 21 CALLE 10
Provider Second Line Business Practice Location Address:
VILLA MATILDE
Provider Business Practice Location Address City Name:
TOA ALTA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-870-7070
Provider Business Practice Location Address Fax Number:
787-870-7852
Provider Enumeration Date:
10/01/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CHEVRES
Authorized Official First Name:
ITZA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
939-645-0504

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  342726 CORP REGISTER , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 9462 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 342726 . This is a "REGISTER CORPORATE NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com