Provider Demographics
NPI:1912398157
Name:PR RENAL HEALTH AND RESEARCH INC
Entity Type:Organization
Organization Name:PR RENAL HEALTH AND RESEARCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OTEGBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-710-2532
Mailing Address - Street 1:PO BOX 51502
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1502
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:939-202-7294
Practice Address - Street 1:600 COMERIO AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-2821
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:939-202-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PREC848AOtherMEDICARE PTAN