Healthcare Provider Details

I. General information

NPI: 1194229088
Provider Name (Legal Business Name): PHM MULTISALUD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 ALDA ST URB CARIBE
SAN JUAN PR
00926-2709
US

IV. Provider business mailing address

1551 ALDA ST URB CARIBE
SAN JUAN PR
00926-2709
US

V. Phone/Fax

Practice location:
  • Phone: 787-625-2500
  • Fax:
Mailing address:
  • Phone: 787-625-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO LUIS BENGOA
Title or Position: PRESIDENT
Credential:
Phone: 787-625-2500