Provider Demographics
NPI:1871790436
Name:FAMILY PRACTICE SPECIALISTS
Entity type:Organization
Organization Name:FAMILY PRACTICE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:V
Authorized Official - Last Name:CARRION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-269-1022
Mailing Address - Street 1:64 CALLE SANTA CRUZ STE 208
Mailing Address - Street 2:CALLE SANTA CRUZ 64
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7004
Mailing Address - Country:US
Mailing Address - Phone:787-269-1022
Mailing Address - Fax:
Practice Address - Street 1:64 CALLE SANTA CRUZ STE 208
Practice Address - Street 2:CALLE SANTA CRUZ 64
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7004
Practice Address - Country:US
Practice Address - Phone:787-269-1022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41761Medicare UPIN
PRG40990Medicare UPIN