Provider Demographics
NPI:1215460142
Name:PDP HEALTH MANAGEMENT, INC.
Entity type:Organization
Organization Name:PDP HEALTH MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ELIZARDO
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:787-470-5826
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:PO BOX 7105
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0261
Mailing Address - Country:US
Mailing Address - Phone:787-812-3153
Mailing Address - Fax:787-842-6372
Practice Address - Street 1:PLAZOLETA MOREL CAMPOS
Practice Address - Street 2:LOCAL #9
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732
Practice Address - Country:US
Practice Address - Phone:787-812-3153
Practice Address - Fax:787-842-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRFF953AMedicare PIN