Provider Demographics
NPI:1386429488
Name:ECOHEALTH MEDICAL GROUP LLC
Entity type:Organization
Organization Name:ECOHEALTH MEDICAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAIARALIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-210-9816
Mailing Address - Street 1:URB LOS MONTES
Mailing Address - Street 2:CALLE FLAMENCO #592
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-210-9816
Mailing Address - Fax:
Practice Address - Street 1:117 ELEANOR ROOSEVELT AVENUE
Practice Address - Street 2:TRES RIOS OFFICE BUILDING SUITE 500
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-705-7979
Practice Address - Fax:787-705-7970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization