Healthcare Provider Details

I. General information

NPI: 1215460142
Provider Name (Legal Business Name): PDP HEALTH MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZOLETA MOREL CAMPOS LOCAL #9
PONCE PR
00732
US

IV. Provider business mailing address

PO BOX 261 PO BOX 7105
PONCE PR
00715-0261
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-3153
  • Fax: 787-842-6372
Mailing address:
  • Phone: 787-812-3153
  • Fax: 787-842-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State

VIII. Authorized Official

Name: MR. JUAN ELIZARDO ALVAREZ
Title or Position: EXECUTIVE DIRECTOR
Credential: J.D.
Phone: 787-470-5826