Provider Demographics
NPI:1225541949
Name:ELDERS OF PUERTO RICO, PSC
Entity Type:Organization
Organization Name:ELDERS OF PUERTO RICO, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRA
Authorized Official - Prefix:
Authorized Official - First Name:EDESTHER
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:CABALLERO-GIPPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:787-530-6633
Mailing Address - Street 1:368 CALLE DE DIEGO APT 602
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-2928
Mailing Address - Country:US
Mailing Address - Phone:787-753-0663
Mailing Address - Fax:
Practice Address - Street 1:368 CALLE DE DIEGO APT 602
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-2928
Practice Address - Country:US
Practice Address - Phone:787-753-0663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3988261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care