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General NPI Number Information
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NPI Number | 1932136470
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Entity Type | Organization
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Legal Business Name | POLICLINICA LA FAMILIA TOA ALTA, INC.
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 10ST #G-21, URB. VILLA MATILDE
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City | TOA ALTA
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State | PR
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Zip | 00953
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Country | US
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Telephone | 787-870-7070
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Fax | 787-870-6382
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Provider Business Mailing Address
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Address Line | PO BOX 867
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City | TOA ALTA
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State | PR
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Zip | 00954-0867
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Country | US
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Telephone | 787-870-7070
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Fax | 787-870-6382
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ITZA D CHEVRES
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Credential | M.D.
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Telephone | 787-870-7121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 13168
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 14703
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 7078
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License Number State | PR
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Taxonomy #4
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 14247
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License Number State | PR
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Taxonomy #5
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 10413
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License Number State | PR
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Taxonomy #6
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 5109
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License Number State | PR
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Taxonomy #7
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2532
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License Number State | PR
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Taxonomy #8
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 9462
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License Number State | PR
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