Healthcare Provider Details

I. General information

NPI: 1497401236
Provider Name (Legal Business Name): PHM MULTIDISCIPLINARY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO. VICTORIA CARRETERA 2 KM 129.3
AGUADILLA PR
00603
US

IV. Provider business mailing address

1551 CALLE ALDA STE 201
SAN JUAN PR
00926-2709
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-1391
  • Fax:
Mailing address:
  • Phone: 787-626-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUZ NURIA TOLEDO
Title or Position: VP OF CLINICS OPERATIONS
Credential:
Phone: 787-396-8784