Provider Demographics
NPI:1770313041
Name:FAMILY MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:FAMILY MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:NIEVES LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-232-7453
Mailing Address - Street 1:HC 73 BOX 4764
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9164
Mailing Address - Country:US
Mailing Address - Phone:939-232-7453
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 167 KM 10.9
Practice Address - Street 2:BO DAJAOS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:939-232-7453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty