Provider Demographics
NPI:1497274286
Name:CAPITOL CLINICAL COMPREHENSIVE LLC
Entity Type:Organization
Organization Name:CAPITOL CLINICAL COMPREHENSIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORTILLA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCDO
Authorized Official - Phone:787-727-1700
Mailing Address - Street 1:PO BOX 8389
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-0389
Mailing Address - Country:US
Mailing Address - Phone:787-727-1700
Mailing Address - Fax:787-982-0152
Practice Address - Street 1:703 CALLE VICTOR LOPEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2843
Practice Address - Country:US
Practice Address - Phone:787-727-1700
Practice Address - Fax:787-727-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty