Provider Demographics
NPI:1457730871
Name:PHYSICIAN HEALTHCARE ADMINISTRATION LLC
Entity Type:Organization
Organization Name:PHYSICIAN HEALTHCARE ADMINISTRATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZBETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUGO
Authorized Official - Suffix:
Authorized Official - Credentials:CSP
Authorized Official - Phone:787-817-3030
Mailing Address - Street 1:PO BOX 140549
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0549
Mailing Address - Country:US
Mailing Address - Phone:787-817-3030
Mailing Address - Fax:
Practice Address - Street 1:CARR 129 KM 0.1
Practice Address - Street 2:AVE SAN LUIS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-817-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18074207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty