Provider Demographics
NPI:1538535315
Name:PRIMARY HEALTH CENTER
Entity type:Organization
Organization Name:PRIMARY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEREZ-VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-362-9116
Mailing Address - Street 1:420 CALLE DIAMANTE
Mailing Address - Street 2:BRISAS DE LAUREL
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2217
Mailing Address - Country:US
Mailing Address - Phone:787-362-9116
Mailing Address - Fax:787-260-6116
Practice Address - Street 1:420 CALLE DIAMANTE
Practice Address - Street 2:BRISAS DE LAUREL
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2217
Practice Address - Country:US
Practice Address - Phone:787-362-9116
Practice Address - Fax:787-260-6116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15493261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22555Medicare PIN