Provider Demographics
NPI:1245608595
Name:PROFESSIONAL MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-743-1985
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0698
Mailing Address - Country:US
Mailing Address - Phone:787-703-3433
Mailing Address - Fax:787-744-6276
Practice Address - Street 1:CARR 931 KM 5.4 SECTOR CIELITO BO NAVARRO
Practice Address - Street 2:PRADERAS SHOPPING MALL
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00783-0698
Practice Address - Country:US
Practice Address - Phone:787-743-1985
Practice Address - Fax:787-744-6276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR110261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care