Provider Demographics
NPI:1225401714
Name:PONCE HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:PONCE HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DROZ
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:787-225-2233
Mailing Address - Street 1:CARR PR 591
Mailing Address - Street 2:EL TUQUE INDUSTRIAL PARK 3025A
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-225-2233
Mailing Address - Fax:
Practice Address - Street 1:CARR PR 591
Practice Address - Street 2:EL TUQUE INDUSTRIAL PARK 3025A
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-225-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health