Healthcare Provider Details

I. General information

NPI: 1265860795
Provider Name (Legal Business Name): PREMIUN HEALTH CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 AVE PONCE DE LEON SUITE 1201
SAN JUAN PR
00910-0000
US

IV. Provider business mailing address

1519 AVE PONCE DE LEON SUITE 1201
SAN JUAN PR
00910-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-562-5168
  • Fax: 787-722-2371
Mailing address:
  • Phone: 787-562-5168
  • Fax: 787-722-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number331348
License Number StatePR

VIII. Authorized Official

Name: MISS YAMILET LOPEZ
Title or Position: PRESIDENT
Credential: MBA
Phone: 787-562-5168