Provider Demographics
NPI:1780923409
Name:BETTY CHINEA,LLC
Entity type:Organization
Organization Name:BETTY CHINEA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-376-0106
Mailing Address - Street 1:COND. CASA MAGGIORE CALLE UNION # 400
Mailing Address - Street 2:APT 518
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-376-0106
Mailing Address - Fax:787-854-0403
Practice Address - Street 1:CALLE UNION #400
Practice Address - Street 2:COND. CASA MAGGIORE APT 518
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-376-0106
Practice Address - Fax:787-854-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12868207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR207RG0100XOtherTAXONOMY
PR0021142OtherMEDICARE
PR12868OtherLICENSE