Provider Demographics
NPI:1427457860
Name:PUERTO RICO PRIMARY HEALTH CARE INC
Entity type:Organization
Organization Name:PUERTO RICO PRIMARY HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YATZMELLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-378-5098
Mailing Address - Street 1:PO BOX 8890
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-8890
Mailing Address - Country:US
Mailing Address - Phone:787-378-5098
Mailing Address - Fax:
Practice Address - Street 1:HEALTHCARE AMBULATORY SERVICES, PLAZA DEL CARMEN MALL
Practice Address - Street 2:NUM. 26
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-9998
Practice Address - Country:US
Practice Address - Phone:787-286-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18705208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty