Healthcare Provider Details

I. General information

NPI: 1780952713
Provider Name (Legal Business Name): TU MEJOR TEMPORADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE SONIA AJ8 VILLA RICA
BAYAMON PR
00959
US

IV. Provider business mailing address

CALLE SONIA AJ8 URB VILLA RICA
BAYAMON PR
00959-4918
US

V. Phone/Fax

Practice location:
  • Phone: 787-904-9810
  • Fax:
Mailing address:
  • Phone: 787-904-9810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number16967
License Number StatePR

VIII. Authorized Official

Name: MRS. MARLENE TORRES MOLINA
Title or Position: SOCIAL WORKER
Credential: TS
Phone: 787-904-9810