Healthcare Provider Details

I. General information

NPI: 1053780833
Provider Name (Legal Business Name): BORINQUEN HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SW 1 STREET MAIMI SENIOR HIGH
MIAMI FL
33135
US

IV. Provider business mailing address

3601 FEDERAL HWY
MIAMI FL
33137-3795
US

V. Phone/Fax

Practice location:
  • Phone: 305-649-9800
  • Fax: 305-649-9475
Mailing address:
  • Phone: 305-576-6611
  • Fax: 786-476-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateFL

VIII. Authorized Official

Name: PAUL C. VELEZ
Title or Position: CEO / PRESIDENT
Credential:
Phone: 305-576-6611