Healthcare Provider Details

I. General information

NPI: 1225401714
Provider Name (Legal Business Name): PONCE HEALTH CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR PR 591 EL TUQUE INDUSTRIAL PARK 3025A
PONCE PR
00728
US

IV. Provider business mailing address

CARR PR 591 EL TUQUE INDUSTRIAL PARK 3025A
PONCE PR
00728
US

V. Phone/Fax

Practice location:
  • Phone: 787-225-2233
  • Fax:
Mailing address:
  • Phone: 787-225-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY DROZ
Title or Position: ADMINISTRATOR
Credential: MHSA
Phone: 787-225-2233