Basic Information
| Provider Information | |||||||||
| NPI: | 1033668876 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELITE NETWORK PHYSICIANS HOME SERVICES PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 212 CALLE LAS MARIAS | ||||||||
| Address2: | HYDE PARK | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009270000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874044258 | ||||||||
| FaxNumber: | 7877213458 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 CALLE LAS MARIAS | ||||||||
| Address2: | HYDE PARK | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874044258 | ||||||||
| FaxNumber: | 7877213458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2016 | ||||||||
| LastUpdateDate: | 09/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | ARTHUR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7874044258 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 383179 | 01 | PR | REGISTRO | OTHER |