Provider Demographics
NPI:1396263083
Name:POLICLINICA MEDICA LA SAGRADA FAMILIA
Entity type:Organization
Organization Name:POLICLINICA MEDICA LA SAGRADA FAMILIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTELLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-928-9002
Mailing Address - Street 1:PO BOX 5004
Mailing Address - Street 2:PMB 301
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698
Mailing Address - Country:US
Mailing Address - Phone:787-717-3553
Mailing Address - Fax:
Practice Address - Street 1:71 CALLE COMERCIO
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3541
Practice Address - Country:US
Practice Address - Phone:787-717-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0000259247261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center