Provider Demographics
NPI:1720230626
Name:GRUPO MEDICO POLICLINICA LA FAMILIA
Entity Type:Organization
Organization Name:GRUPO MEDICO POLICLINICA LA FAMILIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ITZA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHEVRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-870-7121
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00954-0867
Mailing Address - Country:US
Mailing Address - Phone:787-870-7121
Mailing Address - Fax:787-870-6382
Practice Address - Street 1:G21 CALLE 10
Practice Address - Street 2:VILLA MATILDE
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2322
Practice Address - Country:US
Practice Address - Phone:787-870-7121
Practice Address - Fax:787-870-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9462261QM1300X
PR012446261QR0200X
PR2532261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1205814761OtherNPI
PR1588751481OtherNPI
PR1669413720OtherNPI