Provider Demographics
NPI:1669905881
Name:PHANORD FELIPE, JOHANNE
Entity type:Individual
Prefix:
First Name:JOHANNE
Middle Name:
Last Name:PHANORD FELIPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117-14 CALLE 74
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4120
Mailing Address - Country:US
Mailing Address - Phone:787-248-3020
Mailing Address - Fax:
Practice Address - Street 1:1503 CALLE PROF AUGUSTO RODRIGUEZ
Practice Address - Street 2:CONDOMINIO ASIA, 6TO PISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2275
Practice Address - Country:US
Practice Address - Phone:787-497-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service