Provider Demographics
NPI:1811218407
Name:BARCELONETA PRIMARY HEALTH SERVICES INC. (CLINIC NUTRICIONAL)
Entity Type:Organization
Organization Name:BARCELONETA PRIMARY HEALTH SERVICES INC. (CLINIC NUTRICIONAL)
Other - Org Name:ATLANTIC MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LEIDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAZARIO
Authorized Official - Suffix:
Authorized Official - Credentials:MHSA
Authorized Official - Phone:1787-846-4412
Mailing Address - Street 1:PO BOX 2045
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-2045
Mailing Address - Country:US
Mailing Address - Phone:178-784-6441
Mailing Address - Fax:178-784-6741
Practice Address - Street 1:CARR #2 KM 57.8
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-2045
Practice Address - Country:US
Practice Address - Phone:178-784-6441
Practice Address - Fax:178-784-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization