Provider Demographics
NPI:1477201036
Name:SPECIALTY HEALTHCARE CLINIC AT PEPINO LLC
Entity Type:Organization
Organization Name:SPECIALTY HEALTHCARE CLINIC AT PEPINO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:OLAVARRIA INFANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-630-7100
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-1045
Mailing Address - Country:US
Mailing Address - Phone:787-989-0414
Mailing Address - Fax:
Practice Address - Street 1:AVE. EMERITO ESTRADA RIVERA
Practice Address - Street 2:CARR. 125 # 546
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:939-630-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty