MEDICARE: PREMIUN HEALTH CARE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	331348	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	331348	OTHER	PR	LLC

General Provider Information

NPI Number	:	1265860795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUN HEALTH CARE ASSOCIATES

Provider Business Mailing Address
First Line	:	1519 AVE PONCE DE LEON
Second Line	:	SUITE 1201
City	:	SAN JUAN
State	:	PR
Zip	:	00910-0000
Country	:	US
Telephone Number	:	787-562-5168
Fax Number	:	787-722-2371

Provider Business Practice Location Address
First Line	:	1519 AVE PONCE DE LEON
Second Line	:	SUITE 1201
City	:	SAN JUAN
State	:	PR
Zip	:	00910-0000
Country	:	US
Telephone Number	:	787-562-5168
Fax Number	:	787-722-2371

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MISS YAMILET LOPEZ
Credential	:	MBA
Telephone Number	:	787-562-5168

Provider Enumeration Date	:	10/18/2013
Last Update Date	:	10/18/2013

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Directions to “PREMIUN HEALTH CARE ASSOCIATES ” Practice Location

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