Healthcare Provider Details

I. General information

NPI: 1962035832
Provider Name (Legal Business Name): COMMUNITY HEALTH FOUNDATION OF PUERTO RICO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MARGINAL SANTA CRUZ C-17 URB. SANTA CRUZ
BAYAMON PR
00961
US

IV. Provider business mailing address

MARGINAL SANTA CRUZ C-17 URB. SANTA CRUZ
BAYAMON PR
00961
US

V. Phone/Fax

Practice location:
  • Phone: 787-523-3113
  • Fax: 787-786-8690
Mailing address:
  • Phone: 787-523-3113
  • Fax: 787-786-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL
# 8
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: VANIA MEDINA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 787-203-3826