Healthcare Provider Details

I. General information

NPI: 1558039651
Provider Name (Legal Business Name): PUERTO RICO COMMUNITY FOR CLINICAL SERVICES, RESEARCH AND HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/02/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR-21 U3-1, URB. LAS LOMAS
SAN JUAN PR
00921-0092
US

IV. Provider business mailing address

1162 CALLE BRUMBAUGH URB. GARCIA UBARRI
SAN JUAN PR
00925
US

V. Phone/Fax

Practice location:
  • Phone: 787-753-9443
  • Fax:
Mailing address:
  • Phone: 787-753-9443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO RODRIGUEZ
Title or Position: IT DIRECTOR
Credential:
Phone: 787-753-9443