Provider Demographics
NPI:1871738351
Name:PRIME FAMILY CLINIC LLC
Entity type:Organization
Organization Name:PRIME FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-654-7390
Mailing Address - Street 1:PMB 209
Mailing Address - Street 2:425 CARR 693
Mailing Address - City:DORADO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00646
Mailing Address - Country:UM
Mailing Address - Phone:787-654-7390
Mailing Address - Fax:787-654-7397
Practice Address - Street 1:CARR 688 KM 14.1 SABANA BRANCH
Practice Address - Street 2:BO SABANA
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-654-7390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13232261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care