Provider Demographics
NPI:1346008661
Name:ECOHEALTH MEDICAL SYSTEM LLC
Entity Type:Organization
Organization Name:ECOHEALTH MEDICAL SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAIARALIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ HERMINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-210-9816
Mailing Address - Street 1:URB LOS MONTES CALLE FLAMENCO 592
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-210-9816
Mailing Address - Fax:
Practice Address - Street 1:117 ELEANOR ROOSEVELT AVENUE
Practice Address - Street 2:TRES RIOS OFFICE BUILDING SUITE 500
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-705-7979
Practice Address - Fax:787-705-7970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ECOHEALTH MEDICAL GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty