Provider Demographics
NPI:1598248023
Name:BORINQUEN HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:BORINQUEN HEALTH CARE CENTER, INC.
Other - Org Name:BORINQUEN MEDICAL CENTERS - MAIN SITE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-576-6611
Mailing Address - Street 1:3601 FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3795
Mailing Address - Country:US
Mailing Address - Phone:305-576-6611
Mailing Address - Fax:786-476-2818
Practice Address - Street 1:3601 FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3795
Practice Address - Country:US
Practice Address - Phone:305-576-6611
Practice Address - Fax:786-476-2818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BORINQUEN HEALTH CARE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-11
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023294200Medicaid
FL023294201Medicaid