Provider Demographics
NPI:1558748798
Name:LRC MEDICAL PROFESSIONAL SERVICES LLC
Entity Type:Organization
Organization Name:LRC MEDICAL PROFESSIONAL SERVICES LLC
Other - Org Name:LRC MEDICAL PROFESSIONAL SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:CANAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-735-7859
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2000
Mailing Address - Country:US
Mailing Address - Phone:787-735-7859
Mailing Address - Fax:787-954-7501
Practice Address - Street 1:5 CALLE GERONIMO MARTINEZ
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3660
Practice Address - Country:US
Practice Address - Phone:787-735-7859
Practice Address - Fax:787-954-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5047261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care