Provider Demographics
NPI:1679777031
Name:FAMILY HEALTH GROUP, S.S.C.S.P.
Entity type:Organization
Organization Name:FAMILY HEALTH GROUP, S.S.C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRADOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LOPEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-280-7650
Mailing Address - Street 1:PO BOX 5446
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-5446
Mailing Address - Country:US
Mailing Address - Phone:787-280-1650
Mailing Address - Fax:787-280-3074
Practice Address - Street 1:AVE. EMERITO ESTRADA RIVERA
Practice Address - Street 2:CARR 125 SUITE 901
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-5446
Practice Address - Country:US
Practice Address - Phone:787-280-1650
Practice Address - Fax:787-280-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR=========OtherIPA131