FAMILY HEALTH GROUP - NPI NUMBER 1053505503

Summary

Provider Name: FAMILY HEALTH GROUP

NPI Number: 1053505503

Clasification: Clinic/Center (261QH0100X)

Specialization: Health Service

Address:
AVE. EMERITO ESTRADA RIVERA
901
SAN SEBASTIAN, PR
ZIP 00685

Phone Number: (787) 280-1650



Detailed Information

FAMILY HEALTH GROUP is a health service clinic/center in San Sebastian, PR. The assigned NPI number for this provider is 1053505503 and is registered as an organization entity type.

The provider's business address is:

AVE. EMERITO ESTRADA RIVERA
901
SAN SEBASTIAN, PR
ZIP 00685-446
Phone: (787) 280-1650

The provider's authorized official is Israel Lopez .
The authorized official title is Administrador and has the following contact phone number (787) 280-1650.

The enumeration date for this NPI number is 8/28/2007 and was last updated on 4/20/2008.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QH0100X Clinic/Center Health Service PR Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 ========= OTHER PR PATRONAL NUMBER

NPI Record

No. Field Name Field Value
1 NPI 1053505503
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name FAMILY HEALTH GROUP
5 Provider First Line Business Practice Location Address AVE. EMERITO ESTRADA RIVERA
6 Provider Second Line Business Practice Location Address 901
7 Provider Business Practice Location Address City Name SAN SEBASTIAN
8 Provider Business Practice Location Address State Name PR
9 Provider Business Practice Location Address Postal Code 006855446
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 7872801650
12 Provider Enumeration Date 8/28/2007
13 Last Update Date 4/20/2008
14 Authorized Official Last Name LOPEZ
15 Authorized Official First Name ISRAEL
16 Authorized Official Title or Position ADMINISTRADOR
17 Authorized Official Telephone Number 7872801650
18 Healthcare Provider Taxonomy Code 1 261QH0100X
19 Provider License Number State Code 1 PR
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Other Provider Identifier 1 =========
22 Other Provider Identifier Type Code 1 01
23 Other Provider Identifier State 1 PR
24 Other Provider Identifier Issuer 1 PATRONAL NUMBER
25 Is Organization Subpart N
26 Authorized Official Name Prefix Text MR.

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This page was last updated on: 8/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.