Healthcare Provider Details

I. General information

NPI: 1689996647
Provider Name (Legal Business Name): MARKAN MEDICINE CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CALLE ARIOSTO CRUZ
ARECIBO PR
00612-4745
US

IV. Provider business mailing address

PO BOX 4035 SUITE 456
ARECIBO PR
00613-4035
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-3152
  • Fax: 787-880-7733
Mailing address:
  • Phone: 787-878-3151
  • Fax: 787-880-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5
License Number StatePR

VIII. Authorized Official

Name: MANUEL E. MARCANO-RIVERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-878-3151