Healthcare Provider Details

I. General information

NPI: 1306831946
Provider Name (Legal Business Name): MEDNUR CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE COLON # 106
AGUADA PR
00602-3166
US

IV. Provider business mailing address

PO BOX 4789
AGUADILLA PR
00605-4789
US

V. Phone/Fax

Practice location:
  • Phone: 787-252-8330
  • Fax: 787-252-8337
Mailing address:
  • Phone: 787-882-2940
  • Fax: 787-891-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License NumberLIC NUM 1 CNC 00-193
License Number StatePR

VIII. Authorized Official

Name: MRS. GLORIA SANCHEZ
Title or Position: FACTURACION
Credential: MRS
Phone: 787-882-2940