Healthcare Provider Details

I. General information

NPI: 1285140616
Provider Name (Legal Business Name): PREMIER HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 CALLE 1 PUERTO NUEVO NE
SAN JUAN PR
00920
US

IV. Provider business mailing address

PMB 654 BOX 4956
CAGUAS PR
00072
US

V. Phone/Fax

Practice location:
  • Phone: 787-371-1202
  • Fax:
Mailing address:
  • Phone: 787-371-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number StatePR

VIII. Authorized Official

Name: FREDDY SALLENT AQUINO
Title or Position: SECRETARY
Credential:
Phone: 787-371-1202