Healthcare Provider Details

I. General information

NPI: 1760846448
Provider Name (Legal Business Name): FIRST HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 CALLE ROMAN BALDORIOTY DE CASTRO
CIDRA PR
00739
US

IV. Provider business mailing address

17 CALLE 2 STE 520
GUAYNABO PR
00968-1750
US

V. Phone/Fax

Practice location:
  • Phone: 787-247-9542
  • Fax: 787-434-0317
Mailing address:
  • Phone: 787-622-9797
  • Fax: 844-226-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. HUARALI REYES AVILES
Title or Position: FHS GOVERNMENT HEALTH PLAN
Credential: LCDA.
Phone: 787-622-9797