Healthcare Provider Details

I. General information

NPI: 1558205716
Provider Name (Legal Business Name): EDEN HEALTH CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE VICENTITA DELIZ #1,
QUEBRADILLAS PR
00678-0000
US

IV. Provider business mailing address

CALLE VICENTITA DELIZ #1
QEUBRADILLAS PR
00678-0000
US

V. Phone/Fax

Practice location:
  • Phone: 704-534-7997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIANNIE SEGARRA RAMOS
Title or Position: ADMINISTRADOR
Credential:
Phone: 704-534-7997