Provider Demographics
NPI:1124387170
Name:PREMIUM NATURAL CARE .INC
Entity type:Organization
Organization Name:PREMIUM NATURAL CARE .INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-253-1101
Mailing Address - Street 1:AVE. BAIROA B-1 ESQUINA GUARIONEX
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-791-7287
Mailing Address - Fax:
Practice Address - Street 1:ESCORIAL OFFICE BUILDING ONE
Practice Address - Street 2:1400 AVE DE DIEGO SUITE 240
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-4703
Practice Address - Country:US
Practice Address - Phone:787-253-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center