MEDICARE: CLINICA BIENESTAR

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1770900755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA BIENESTAR

Provider Business Mailing Address
First Line	:	1233 LOCUST ST
Second Line	:	3RD FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5453
Country	:	US
Telephone Number	:	215-985-4448
Fax Number	:	215-985-4952

Provider Business Practice Location Address
First Line	:	166 W LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-3849
Country	:	US
Telephone Number	:	215-790-1788
Fax Number	:	215-732-5490

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	BERNARD SOLOMON
Credential	:
Telephone Number	:	215-985-4448

Provider Enumeration Date	:	03/27/2014
Last Update Date	:	03/27/2014

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