Healthcare Provider Details

I. General information

NPI: 1144502964
Provider Name (Legal Business Name): ADVANCE WOUND CARE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB MARIOLGA V 27 AVE MUNOZ MARIN
CAGUAS PR
00725
US

IV. Provider business mailing address

URB MARIOLGA V 27 AVE MUNOZ MARIN
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-595-0385
  • Fax: 787-735-7613
Mailing address:
  • Phone: 787-595-0385
  • Fax: 787-735-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: YOSELYN MERCADO
Title or Position: PRESIDENTA
Credential:
Phone: 787-595-0385