Provider Demographics
NPI:1881003382
Name:PRO-HEALTH CLINICAL SERVICES LLC
Entity Type:Organization
Organization Name:PRO-HEALTH CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:COMULADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-451-1363
Mailing Address - Street 1:PO BOX 52192
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-2192
Mailing Address - Country:US
Mailing Address - Phone:787-451-1363
Mailing Address - Fax:
Practice Address - Street 1:CALLE MANUEL ROSSY ESQUINA ISABEL SEGUNDA
Practice Address - Street 2:BAYAMON HEALTH CENTER
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-451-1363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty