Healthcare Provider Details

I. General information

NPI: 1679777031
Provider Name (Legal Business Name): FAMILY HEALTH GROUP, S.S.C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. EMERITO ESTRADA RIVERA CARR 125 SUITE 901
SAN SEBASTIAN PR
00685-5446
US

IV. Provider business mailing address

PO BOX 5446
SAN SEBASTIAN PR
00685-5446
US

V. Phone/Fax

Practice location:
  • Phone: 787-280-1650
  • Fax: 787-280-3074
Mailing address:
  • Phone: 787-280-1650
  • Fax: 787-280-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LOPEZ ISRAEL
Title or Position: ADMINISTRADOR
Credential:
Phone: 787-280-7650