Provider Demographics
NPI:1417439456
Name:PUERTO RICO HEALTH MANAGEMENT
Entity Type:Organization
Organization Name:PUERTO RICO HEALTH MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRASQUILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-444-4908
Mailing Address - Street 1:ESCORIAL OFFICE BUILDING ONE 1400
Mailing Address - Street 2:AVE. DE DIEGO SUITE 300
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4703
Mailing Address - Country:US
Mailing Address - Phone:787-444-4908
Mailing Address - Fax:
Practice Address - Street 1:ESCORIAL OFFICE BUILDING ONE 1400
Practice Address - Street 2:AVE. DE DIEGO SUITE 300
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-4703
Practice Address - Country:US
Practice Address - Phone:787-444-4908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4296OtherSTATE LICENCE