Healthcare Provider Details

I. General information

NPI: 1639016819
Provider Name (Legal Business Name): FAMILY CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MARGINAL RAMAL 484,BO COCOS SECTOR LAS PIEDRAS 162
QUEBRADILLAS PR
00678-0000
US

IV. Provider business mailing address

ESTANCIAS PARAISO #209 CALLE CIRUELO
ISABELA PR
00662-3927
US

V. Phone/Fax

Practice location:
  • Phone: 787-280-8776
  • Fax:
Mailing address:
  • Phone: 787-312-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLNELSA REY
Title or Position: MD
Credential: MD
Phone: 787-312-1243