Healthcare Provider Details

I. General information

NPI: 1518765858
Provider Name (Legal Business Name): PHP ELITE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. CAIMITAL CARR PR 2 KM 122.0
AGUADILLA PR
00605
US

IV. Provider business mailing address

1250 AVE PONCE DE LEON STE 204
SAN JUAN PR
00907-3949
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-0171
  • Fax:
Mailing address:
  • Phone: 787-641-0171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HIRAM J ORTEGA
Title or Position: PRESIDENT
Credential:
Phone: 787-431-6710