MEDICARE: PRIMARY CARE PROVIDERS NETWORK, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1336561166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE PROVIDERS NETWORK, LLC

Provider Business Mailing Address
First Line	:	20 CALLE SANTA CRUZ
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00961-6906
Country	:	US
Telephone Number	:	787-778-0315
Fax Number	:	787-778-0330

Provider Business Practice Location Address
First Line	:	20 CALLE SANTA CRUZ
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00961-6906
Country	:	US
Telephone Number	:	787-778-0315
Fax Number	:	787-778-0330

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. OMAR A CANDELAS
Credential	:
Telephone Number	:	787-778-0315

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/14/2014

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Directions to “PRIMARY CARE PROVIDERS NETWORK, LLC ” Practice Location

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