Provider Demographics
NPI:1154899128
Name:PHM MULTIDISCIPLINARY CLINIC LLC
Entity type:Organization
Organization Name:PHM MULTIDISCIPLINARY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BENGOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-625-2500
Mailing Address - Street 1:1551 CALLE ALDA SUITE 201 URB CARIBE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-650-2732
Mailing Address - Fax:787-650-2734
Practice Address - Street 1:B11 CALLE 2
Practice Address - Street 2:URBANIZACION VILLA REAL
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-1156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty