Provider Demographics
NPI:1265860795
Name:PREMIUN HEALTH CARE ASSOCIATES
Entity Type:Organization
Organization Name:PREMIUN HEALTH CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:YAMILET
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:787-562-5168
Mailing Address - Street 1:1519 AVE PONCE DE LEON
Mailing Address - Street 2:SUITE 1201
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0000
Mailing Address - Country:US
Mailing Address - Phone:787-562-5168
Mailing Address - Fax:787-722-2371
Practice Address - Street 1:1519 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 1201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00910-0000
Practice Address - Country:US
Practice Address - Phone:787-562-5168
Practice Address - Fax:787-722-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR331348305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR331348OtherLLC