Provider Demographics
NPI:1487956082
Name:PHYSICIAN MANAGEMENT CORPORATION OF AMERICA
Entity type:Organization
Organization Name:PHYSICIAN MANAGEMENT CORPORATION OF AMERICA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SULTAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-523-2900
Mailing Address - Street 1:PO BOX 364109
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-4109
Mailing Address - Country:US
Mailing Address - Phone:787-523-2900
Mailing Address - Fax:787-957-6220
Practice Address - Street 1:282 PINERO AVE.
Practice Address - Street 2:SUITE 200C
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-523-2900
Practice Address - Fax:787-957-6220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X, 3336S0011X
PR17-F-29673336L0003X, 3336L0003X
PR15-F-29673336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2126977OtherPK