Provider Demographics
NPI:1205239589
Name:FAMILY HEALTH CLINIC OF CARIBBEAN, INC
Entity type:Organization
Organization Name:FAMILY HEALTH CLINIC OF CARIBBEAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ITZA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHEVRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-645-0504
Mailing Address - Street 1:PO BOX 867
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00954
Mailing Address - Country:UM
Mailing Address - Phone:787-870-7852
Mailing Address - Fax:787-870-7852
Practice Address - Street 1:G 21 CALLE 10
Practice Address - Street 2:VILLA MATILDE
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:787-870-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR342726 CORP REGISTER261Q00000X
PR9462208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR342726OtherREGISTER CORPORATE NUMBER