Healthcare Provider Details

I. General information

NPI: 1306223797
Provider Name (Legal Business Name): M.C.M ULCER CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 3 BOX 32695
AGUADA PR
00602-9764
US

IV. Provider business mailing address

HC 3 BOX 32695
AGUADA PR
00602-9764
US

V. Phone/Fax

Practice location:
  • Phone: 787-202-1357
  • Fax:
Mailing address:
  • Phone: 787-202-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number73498
License Number StatePR

VIII. Authorized Official

Name: MS. MARILYN CRUZ MONTALVO
Title or Position: ENFERMERA GENERALITA
Credential: BACHILLERATO
Phone: 787-202-1357