Provider Demographics
NPI:1720505548
Name:PHM MULTIDISCIPLINARY CLINIC LLC
Entity Type:Organization
Organization Name:PHM MULTIDISCIPLINARY CLINIC LLC
Other - Org Name:CLINICA DE AGUADIILA
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL AND HEALTH SERVICES DIRECTO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALESKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-407-8764
Mailing Address - Street 1:1551 CALLE ALDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2709
Mailing Address - Country:US
Mailing Address - Phone:787-658-1389
Mailing Address - Fax:787-658-1392
Practice Address - Street 1:BO. VICTORIA CARRETERA 2 KM 129.3
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-1389
Practice Address - Fax:787-658-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty