Provider Demographics
NPI:1841680022
Name:LOG HEALTHCARE SERVICES PSC
Entity type:Organization
Organization Name:LOG HEALTHCARE SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:GARCIA COLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-365-1878
Mailing Address - Street 1:216 MANSIONES DEL GOLF
Mailing Address - Street 2:CAGUAS REAL
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-0009
Mailing Address - Country:US
Mailing Address - Phone:787-365-1878
Mailing Address - Fax:
Practice Address - Street 1:1472 COND PUERTA DEL PARQUE
Practice Address - Street 2:HACIENDA SAN JOSE
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-3146
Practice Address - Country:US
Practice Address - Phone:787-365-1878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16571172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty