Provider Demographics
NPI:1538310040
Name:IPA 508 BELAVAL
Entity Type:Organization
Organization Name:IPA 508 BELAVAL
Other - Org Name:JUNTA DEL CENTRO DE SALUD COMUNAL DR. JOSE S. BELAVAL, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH EDUCATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DAMARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-268-4171
Mailing Address - Street 1:PO BOX 14457
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00916-4457
Mailing Address - Country:US
Mailing Address - Phone:787-268-4171
Mailing Address - Fax:787-727-3695
Practice Address - Street 1:2003 AVE BORINQUEN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3814
Practice Address - Country:US
Practice Address - Phone:787-268-4171
Practice Address - Fax:787-727-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR156261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)