Provider Demographics
NPI:1285102269
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 STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2709
Mailing Address - Country:US
Mailing Address - Phone:787-650-2732
Mailing Address - Fax:787-650-2734
Practice Address - Street 1:GALERIA 100 SHOPPING CENTER CARRETERA 100 KM 6.6
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-658-1389
Practice Address - Fax:787-658-1392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHM MULTIDISCIPLINARY CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty