Provider Demographics
NPI:1235621012
Name:PRO CLINIC HEALTH, PSC
Entity Type:Organization
Organization Name:PRO CLINIC HEALTH, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:FORTI ISALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-552-5520
Mailing Address - Street 1:8 AVE LAS CUMBRES # KM 1/2
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4818
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 AVENIDA LAS CUMBRES KM 1.2
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-552-5520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty