NPIMap

Organization Active NPI

Premium Health Group Clinic LLC

  • Diagnostic Radiology Physician
  • Carolina, PR
National Provider Identifier
1558929752
Registry record updated May 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
PREMIUM HEALTH GROUP CLINIC LLC
Practice address
Laguna Gardens Shopping Center
Suite 101a
Carolina, PR 00979
Phone
(787) 444-4908
NPI assigned
Jun 3, 2019
Organization subpart
Yes
Parent organization
PREMIUM HEALTH GROUP CLINIC LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Luz Villanueva
Title
Ceo
Phone
(787) 253-1101

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085B0100X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary

Addresses

Primary practice location

Laguna Gardens Shopping Center
Suite 101a
Carolina, PR 00979

Mailing address

Laguna Gardens Shopping Center
Suite 101a
Carolina, PR 00979
Phone (787) 444-4908

National Provider Directory

National Provider Directory
Tax ID family
Premium Health Group Clinic3 organizations share this tax ID, including this one
Part of
Premium Health Group Clinic

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588809600000",
    "number": "1558929752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "LAGUNA GARDENS SHOPPING CENTER",
            "address_2": "SUITE 101A",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "00979",
            "telephone_number": "787-444-4908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LAGUNA GARDENS SHOPPING CENTER",
            "address_2": "SUITE 101A",
            "city": "CAROLINA",
            "state": "PR",
            "postal_code": "00979",
            "telephone_number": "787-444-4908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM HEALTH GROUP CLINIC LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PREMIUM HEALTH GROUP CLINIC LLC",
        "enumeration_date": "2019-06-03",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A",
        "authorized_official_last_name": "VILLANUEVA",
        "authorized_official_first_name": "LUZ",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "787-253-1101"
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carolina, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.