Provider Demographics
NPI:1962626960
Name:PROFESSIONAL HEALTH GROUP INC.
Entity Type:Organization
Organization Name:PROFESSIONAL HEALTH GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN RHYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-780-8454
Mailing Address - Street 1:400 CALLE JUAN CALAF
Mailing Address - Street 2:SUITE 361
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-780-8454
Mailing Address - Fax:787-779-2329
Practice Address - Street 1:14 AVE BETANCES
Practice Address - Street 2:URB. HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5200
Practice Address - Country:US
Practice Address - Phone:787-730-8840
Practice Address - Fax:787-740-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR07-B-2481261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility