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Organization

PREMIUM COMMUNITY CLINIC LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS JENNY YVETTE MARRERO MELENDEZ (PRESIDENT)
(787) 444-4211
Entity
Organization

Contact information

Practice address
4X2 AVE NOGAL, LOMAS VERDES, BAYAMON, PR 00956-2967
(787) 444-4211
(787) 791-6273
Mailing address
PO BOX 51881, TOA BAJA, PR 00950-1881
(787) 444-4211
(787) 791-6273

Taxonomy

Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
PR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4021902
DRIVER LICENSE
PR
Enumeration date
07/04/2013
Last updated
07/04/2013
About Stedi
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Product
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  • Eligibility checks
  • EDI platform