Healthcare Provider Details

I. General information

NPI: 1962626960
Provider Name (Legal Business Name): PROFESSIONAL HEALTH GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 AVE BETANCES URB. HERMANAS DAVILA
BAYAMON PR
00959-5200
US

IV. Provider business mailing address

400 CALLE JUAN CALAF SUITE 361
SAN JUAN PR
00918-1314
US

V. Phone/Fax

Practice location:
  • Phone: 787-730-8840
  • Fax: 787-740-8841
Mailing address:
  • Phone: 787-780-8454
  • Fax: 787-779-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number07-B-2481
License Number StatePR

VIII. Authorized Official

Name: MR. PEDRO VAN RHYN
Title or Position: PRESIDENT
Credential:
Phone: 787-780-8454