Provider Demographics
NPI:1063076768
Name:FRC MEDICAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:FRC MEDICAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT,TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:RUIZ DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-841-4308
Mailing Address - Street 1:PO BOX 7251
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7251
Mailing Address - Country:US
Mailing Address - Phone:787-841-4308
Mailing Address - Fax:787-829-1096
Practice Address - Street 1:10 CALLE RIUS RIVERA
Practice Address - Street 2:
Practice Address - City:ADJUNTAS
Practice Address - State:PR
Practice Address - Zip Code:00601-2335
Practice Address - Country:US
Practice Address - Phone:787-829-1096
Practice Address - Fax:787-829-0251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care