Provider Demographics
NPI:1417251273
Name:PDP HEALTH MANAGEMENT INC
Entity Type:Organization
Organization Name:PDP HEALTH MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-812-3193
Mailing Address - Street 1:PMB 261
Mailing Address - Street 2:APTDO 7105
Mailing Address - City:PONCE
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00732
Mailing Address - Country:UM
Mailing Address - Phone:787-812-3193
Mailing Address - Fax:787-290-6689
Practice Address - Street 1:PLAZOLETA MOREL CAMPOS
Practice Address - Street 2:LOCAL #9
Practice Address - City:PONCE
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00732
Practice Address - Country:UM
Practice Address - Phone:787-812-3193
Practice Address - Fax:787-290-6689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center