| Elite Medical Clinic Of Pr Llc | |
|
400 Ave Domenech Ste 412 Las Americas Professional Center San Juan PR 00918-3748 | |
| (787) 945-0767 | |
| Not Available |
| Full Name | Elite Medical Clinic Of Pr Llc |
|---|---|
| Speciality | General Practice |
| Location | 400 Ave Domenech Ste 412, San Juan, Puerto Rico |
| Authorized Official Name and Position | Yadira Dominguez Vazquez (PRESIDENT) |
| Authorized Official Contact | 7872397575 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Medical Clinic Of Pr Llc 400 Ave Domenech Ste 412 Las Americas Professional Center San Juan PR 00918-3748 Ph: (787) 945-0767 | Elite Medical Clinic Of Pr Llc 400 Ave Domenech Ste 412 Las Americas Professional Center San Juan PR 00918-3748 Ph: (787) 945-0767 |
| NPI Number | 1093347692 |
|---|---|
| Provider Enumeration Date | 02/11/2020 |
| Last Update Date | 02/11/2020 |
| Medicare PECOS PAC ID | 8729415666 |
|---|---|
| Medicare Enrollment ID | O20200305001005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093347692 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Hector Casas |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255703351 PECOS PAC ID: 1052617560 Enrollment ID: I20160309002401 |
| Provider Name | Yadira Dominguez Vazquez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1003288143 PECOS PAC ID: 9537465059 Enrollment ID: I20160309002626 |
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