Provider Demographics
NPI:1194244657
Name:CONDADO WELLNESS CENTER
Entity type:Organization
Organization Name:CONDADO WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-798-0100
Mailing Address - Street 1:100 PASEO SAN PABLO
Mailing Address - Street 2:SUITE 503
Mailing Address - City:BAYAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-798-0100
Mailing Address - Fax:
Practice Address - Street 1:150 AVE DE DIEGO SUITE 201
Practice Address - Street 2:2 PIDO SAN JUAN HEALTH CENTRE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2398
Practice Address - Country:US
Practice Address - Phone:787-230-7557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARIBBEAN HEALTHCARE MANAGEMENT GROU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-15
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty