Healthcare Provider Details

I. General information

NPI: 1295053163
Provider Name (Legal Business Name): ASSMCA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 CALLE 2 BO JUAN SANCHEZ
BAYAMON PR
00960
US

IV. Provider business mailing address

HC-65 BZN 7579 BO CERRO GORDO
VEGA ALTA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-7575
  • Fax: 787-995-5174
Mailing address:
  • Phone: 787-568-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number26852
License Number StatePR

VIII. Authorized Official

Name: MR. VICTOR MANUEL GARCIA
Title or Position: NURSING
Credential: RN
Phone: 787-568-3043