Provider Demographics
NPI:1114542016
Name:PREFERRED PODIATRY NETWORK OF PUERTO RICO, LLC
Entity Type:Organization
Organization Name:PREFERRED PODIATRY NETWORK OF PUERTO RICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAGUER
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:787-435-2292
Mailing Address - Street 1:100 PASEO SAN PABLO
Mailing Address - Street 2:EDIF DR. ARTURO CADILLA OFIC 409
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-435-2292
Mailing Address - Fax:
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:EDIF DR. ARTURO CADILLA OFIC 409
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-435-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty