Healthcare Provider Details

I. General information

NPI: 1639518095
Provider Name (Legal Business Name): CHAMPI MEDICAL AND WELLNESS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CALLE MARIA MONAGAS LOCAL #1 ESQUINA 65 INFANTERIA
ANASCO PR
00610
US

IV. Provider business mailing address

PO BOX 619
ANASCO PR
00610-0619
US

V. Phone/Fax

Practice location:
  • Phone: 787-229-1223
  • Fax: 787-229-1332
Mailing address:
  • Phone: 787-229-1223
  • Fax: 787-229-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StatePR
# 9
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StatePR
# 10
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StatePR

VIII. Authorized Official

Name: DR. RICARDO LUIS MACHADO-TORRES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-229-1223