Healthcare Provider Details

I. General information

NPI: 1457507790
Provider Name (Legal Business Name): ASOCIACION DE PUERTORRIQUENOS EN MARCHA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 N 6TH ST
PHILADELPHIA PA
19122-1415
US

IV. Provider business mailing address

4301 RISING SUN AVE
PHILADELPHIA PA
19140-2719
US

V. Phone/Fax

Practice location:
  • Phone: 215-236-0315
  • Fax: 215-235-4581
Mailing address:
  • Phone: 267-296-7200
  • Fax: 215-455-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. NILDA RUIZ
Title or Position: PRESIDENT
Credential:
Phone: 267-296-7200