Provider Demographics
NPI:1851579155
Name:POLICLINICA LA FAMILIA DE TOA ALTA INC
Entity Type:Organization
Organization Name:POLICLINICA LA FAMILIA DE TOA ALTA INC
Other - Org Name:POLICLINICA LA FAMILIA DE TOA ALTA INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEVRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-870-7000
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:787-870-7070
Mailing Address - Fax:787-870-6382
Practice Address - Street 1:CALLE 10 G 12 URB VILLA MATILDE
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-870-7070
Practice Address - Fax:787-870-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12F25833336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4026046OtherNCPDP PROVIDER IDENTIFICATION NUMBER