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General NPI Number Information
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NPI Number | 1235837527
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Entity Type | Organization
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Legal Business Name | PRIMARY HEALTH LLC
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | CARR. 31 KM 4.0
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City | NAGUABO
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State | PR
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Zip | 00718
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Country | US
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Telephone | 787-874-3152
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Fax |
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Provider Business Mailing Address
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Address Line | 1341 CALLE ALDEA APT TH1
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City | SAN JUAN
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State | PR
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Zip | 00907-2320
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Country | US
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Telephone | 787-905-3772
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JOSE M DE JESUS
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Credential | OD, MD
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Telephone | 787-905-3772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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