Healthcare Provider Details

I. General information

NPI: 1235837527
Provider Name (Legal Business Name): PRIMARY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 31 KM 4.0
NAGUABO PR
00718
US

IV. Provider business mailing address

1341 CALLE ALDEA APT TH1
SAN JUAN PR
00907-2320
US

V. Phone/Fax

Practice location:
  • Phone: 787-874-3152
  • Fax:
Mailing address:
  • Phone: 787-905-3772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE M DE JESUS
Title or Position: MANAGING MEMBER
Credential: OD, MD
Phone: 787-905-3772