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General NPI Number Information
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NPI Number | 1235621012
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Entity Type | Organization
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Legal Business Name | PRO CLINIC HEALTH, PSC
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 8 AVENIDA LAS CUMBRES KM 1.2
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City | GUAYNABO
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State | PR
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Zip | 00970
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Country | US
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Telephone | 787-552-5520
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Fax |
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Provider Business Mailing Address
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Address Line | 8 AVE LAS CUMBRES # KM 1/2
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City | GUAYNABO
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State | PR
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Zip | 00969-4818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUIS RAUL FORTI ISALES
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Credential | MD
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Telephone | 787-552-5520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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