Provider Demographics
NPI:1184005753
Name:LIONFISH MEDICAL CLINIC PSC
Entity Type:Organization
Organization Name:LIONFISH MEDICAL CLINIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:PRATS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-830-0211
Mailing Address - Street 1:PO BOX 1092
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-1092
Mailing Address - Country:US
Mailing Address - Phone:787-830-0211
Mailing Address - Fax:787-609-6054
Practice Address - Street 1:52 AVE JOSE C BARBOSA
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-0211
Practice Address - Fax:787-609-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14494208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty