Provider Demographics
NPI:1326653247
Name:PHM MULTIDISCIPLINARY CLINIC MAUNABO LLC
Entity Type:Organization
Organization Name:PHM MULTIDISCIPLINARY CLINIC MAUNABO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:L
Authorized Official - Last Name:BENGOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-625-2500
Mailing Address - Street 1:1551 ALDA ST
Mailing Address - Street 2:URB. CARIBE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-625-2500
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA 53
Practice Address - Street 2:EDIF. ADYACENTE CDT MAUNABO
Practice Address - City:MAUNABO
Practice Address - State:PR
Practice Address - Zip Code:00707
Practice Address - Country:US
Practice Address - Phone:787-625-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty