Healthcare Provider Details

I. General information

NPI: 1205239589
Provider Name (Legal Business Name): FAMILY HEALTH CLINIC OF CARIBBEAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G 21 CALLE 10 VILLA MATILDE
TOA ALTA PR
00953
US

IV. Provider business mailing address

PO BOX 867
TOA ALTA PUERTO RICO
00954
UM

V. Phone/Fax

Practice location:
  • Phone: 787-870-7070
  • Fax: 787-870-7852
Mailing address:
  • Phone: 787-870-7852
  • Fax: 787-870-7852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9462
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number342726 CORP REGISTER
License Number StatePR

VIII. Authorized Official

Name: MS. ITZA D CHEVRES
Title or Position: PRESIDENT
Credential: MD
Phone: 939-645-0504