Provider Demographics
NPI:1124774054
Name:PHM MULTIDISCIPLINARY CLINIC LLC
Entity type:Organization
Organization Name:PHM MULTIDISCIPLINARY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:NURIA
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-396-8784
Mailing Address - Street 1:1551 CALLE ALDA, SUITE 201
Mailing Address - Street 2:URB. CARIBE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2709
Mailing Address - Country:US
Mailing Address - Phone:787-626-2500
Mailing Address - Fax:
Practice Address - Street 1:CALLE PALMER ESQ VICENTE PALES NUM 51
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00785
Practice Address - Country:US
Practice Address - Phone:787-866-1449
Practice Address - Fax:787-866-5148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service