Healthcare Provider Details

I. General information

NPI: 1558832360
Provider Name (Legal Business Name): PREMIER MEDICAL CENTER OF MAYAGUEZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 04/30/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA SULTANA CARR. #2 KM 152
MAYAGUEZ PR
00682-1343
US

IV. Provider business mailing address

PMB 620 PO BOX 4952
CAGUAS PR
00726-4952
US

V. Phone/Fax

Practice location:
  • Phone: 787-792-5389
  • Fax:
Mailing address:
  • Phone: 787-286-6060
  • Fax: 225-214-9349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LUZ N TOLEDO NUNEZ
Title or Position: CLINICS STRATEGY
Credential:
Phone: 787-286-6060