Provider Demographics
NPI:1053505503
Name:FAMILY HEALTH GROUP
Entity Type:Organization
Organization Name:FAMILY HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ISRAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-280-1650
Mailing Address - Street 1:PO BOX 5446
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-5446
Mailing Address - Country:US
Mailing Address - Phone:787-280-1650
Mailing Address - Fax:
Practice Address - Street 1:AVE. EMERITO ESTRADA RIVERA
Practice Address - Street 2:901
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-5446
Practice Address - Country:US
Practice Address - Phone:787-280-1650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherPATRONAL NUMBER